Methods: Infants ≤60 days old with documented or reported fever ≥38C were included. Infants were divided into age groups ≤28 days and 29-60 days, based on differential CPG recommendations for these age groups. Data were further divided by time frames pre- and post-CPG implementation (1/1/09 – 1/31/11 and 2/1/11 – 1/31/13, respectively). Proportion of infants with documented HSV risk factors and HSV testing (items given explicit recommendations within the algorithm and order set) were compared to proportion of infants with documented previous antibiotic exposure, maternal group B streptococcal (GBS) colonized status, or maternal perinatal fever (not specified in algorithm or order set).
Results: A total of 967 infants were identified pre-CPG and 843 infants post-CPG. For infants 0-28 days old, documentation of maternal GBS status decreased post-CPG (75% vs 67%, p=0.0279) and maternal HSV documentation increased (34% vs 43%, p=0.035). In the 29-60 day age group, HSV testing decreased (14% vs 9%, p=0.0055). Maternal perinatal fever documentation or previous antibiotic exposure did not change post-CPG.
Conclusion: HSV testing and risk documentation, both items specified in the order set and algorithm, increased with CPG implementation, while other relevant documentation not specified in the CPG, algorithm, or order set were unchanged or decreased, suggesting that the presence of embedded prompts may affect clinician decision-making. Our results highlight the need to further study the potential impact of embedded prompts in algorithms and order sets on clinician decision-making.
J. Newland, Pfizer/Joint Commission: Grant Investigator , Research grant
RPSdiagnostics: Consultant , Consulting fee
K. Mann, None
J. Michael, None
J. Bartlett, None
M. Barnes, None
R. Chan, None
R. Mcculloh, None