475. Assessing the Impact of Electronic Order Sets and Algorithm Implementation on Clinician Practice Patterns in the Management of Febrile Infants
Session: Poster Abstract Session: Pediatric Viral Infections
Thursday, October 8, 2015
Room: Poster Hall
Background: Clinical practice guidelines (CPGs) are intended to improve adherence to evidence-based practices. Successful implementation may require a variety of interventions. Understanding what interventions are associated with changes in clinician behavior is therefore important to improvement efforts. A CPG for managing febrile infants was implemented in an urban children’s hospital with simultaneous implementation of an electronic order set and publication of an algorithm to guide clinical decisions for testing infants for serious bacterial infection (SBI) and herpes simplex virus (HSV). This study aimed to determine the association of CPG, algorithm, and order set implementation with physician documentation practices in febrile infant evaluation.

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.

Tessa Commers, MD1, David Williams, MPH2, Jason Newland, MD, MEd, FPIDS3, Keith Mann, MD, MEd4, Jeffrey Michael, DO5, Jacqueline Bartlett, RN, PhD6, Mitchell Barnes, BS7, Raymond Chan, MD1 and Russell Mcculloh, MD8, (1)Pediatrics`, Children's Mercy Kansas City, Kansas City, MO, (2)Quality Improvement, Children's Mercy Hospitals & Clinics, Kansas City, MO, (3)Children's Mercy Hospital and Clinics, Kansas City, MO, (4)Quality Improvement, Children's Mercy Hospital and Clinics, Kansas City, MO, (5)Emergency Medicine, Children's Mercy Kansas City, Kansas City, MO, (6)Evidence Based Practice, Children's Mercy Hospital, Kansas City, MO, (7)Medical Informatics, Children's Mercy Kansas City, Kansas City, MO, (8)Pediatrics, Children's Mercy Hospitals & Clinics and University of Missouri-Kansas City, Kansas City, MO

Disclosures:

T. Commers, None

D. Williams, None

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

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