The impact of a point‐of‐care visual clinical decision support tool on admissions for cellulitis in the University of Maryland medical system
Abstract Introduction Cellulitis is commonly diagnosed in emergency departments (EDs), yet roughly one third of ED patients admitted for presumed cellulitis have another, usually benign, condition instead (eg, stasis dermatitis). This suggests there is an opportunity to reduce health care resource u...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-06-01
|
| Series: | Journal of the American College of Emergency Physicians Open |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/emp2.12969 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849397856101728256 |
|---|---|
| author | Zachary D.W. Dezman Daniel Lemkin Art Papier Brian Browne |
| author_facet | Zachary D.W. Dezman Daniel Lemkin Art Papier Brian Browne |
| author_sort | Zachary D.W. Dezman |
| collection | DOAJ |
| description | Abstract Introduction Cellulitis is commonly diagnosed in emergency departments (EDs), yet roughly one third of ED patients admitted for presumed cellulitis have another, usually benign, condition instead (eg, stasis dermatitis). This suggests there is an opportunity to reduce health care resource use through improved diagnosis at the point of care. This study seeks to test whether a clinical decision support (CDS) tool interoperable with the electronic medical record (EMR) can reduce inappropriate hospital admissions and drive more appropriate and accurate care. Methods This study was a trial of an EMR‐interoperable, image‐based CDS tool for evaluation of ED patients with suspected cellulitis. At the point of assigning a provisional diagnosis of cellulitis in the EMR, the clinician was randomly prompted to use the CDS. Based on the patient features entered into the CDS by the clinician, the CDS provided the clinician a list of likely diagnoses. The following were recorded: patient demographics, disposition and final diagnosis of patients, and whether antibiotics were prescribed. Logistic regression methods were used to determine the impact of CDS engagement on our primary outcome of admission for cellulitis, adjusted for patient factors. Antibiotic use was a secondary end point. Results From September 2019 to February 2020 (or 7 months), the CDS tool was deployed in the EMR at 4 major hospitals in the University of Maryland Medical System. There were 1269 encounters for cellulitis during the study period. The engagement with the CDS was low (24.1%, 95/394), but engagement was associated with an absolute reduction in admissions (7.1%, p = 0.03). After adjusting for age greater than 65 years, female sex, non‐White race, and private insurance, CDS engagement was associated with a significant reduction of admissions (adjusted OR = 0.62, 95% confidence interval (CI): 0.40–0.97, p = 0.04) and antibiotic use (Adjusted OR = 0.63, 95% CI: 0.40–0.99, p = 0.04). Conclusions CDS engagement was associated with decreased admissions for cellulitis and decreased antibiotic use in this study, despite low levels of CDS engagement. Further research should examine the impact of CDS engagement in other practice environments and measure longer‐term outcomes in patients discharged from the ED. |
| format | Article |
| id | doaj-art-a72c979e43b445a9be36f6e094e7891c |
| institution | Kabale University |
| issn | 2688-1152 |
| language | English |
| publishDate | 2023-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj-art-a72c979e43b445a9be36f6e094e7891c2025-08-20T03:38:49ZengElsevierJournal of the American College of Emergency Physicians Open2688-11522023-06-0143n/an/a10.1002/emp2.12969The impact of a point‐of‐care visual clinical decision support tool on admissions for cellulitis in the University of Maryland medical systemZachary D.W. Dezman0Daniel Lemkin1Art Papier2Brian Browne3Department of Emergency Medicine University of Maryland School of Medicine University of Maryland Baltimore Maryland USADepartment of Emergency Medicine University of Maryland School of Medicine University of Maryland Baltimore Maryland USADepartment of Dermatology University of Rochester School of Medicine Rochester New York USADepartment of Emergency Medicine University of Maryland School of Medicine University of Maryland Baltimore Maryland USAAbstract Introduction Cellulitis is commonly diagnosed in emergency departments (EDs), yet roughly one third of ED patients admitted for presumed cellulitis have another, usually benign, condition instead (eg, stasis dermatitis). This suggests there is an opportunity to reduce health care resource use through improved diagnosis at the point of care. This study seeks to test whether a clinical decision support (CDS) tool interoperable with the electronic medical record (EMR) can reduce inappropriate hospital admissions and drive more appropriate and accurate care. Methods This study was a trial of an EMR‐interoperable, image‐based CDS tool for evaluation of ED patients with suspected cellulitis. At the point of assigning a provisional diagnosis of cellulitis in the EMR, the clinician was randomly prompted to use the CDS. Based on the patient features entered into the CDS by the clinician, the CDS provided the clinician a list of likely diagnoses. The following were recorded: patient demographics, disposition and final diagnosis of patients, and whether antibiotics were prescribed. Logistic regression methods were used to determine the impact of CDS engagement on our primary outcome of admission for cellulitis, adjusted for patient factors. Antibiotic use was a secondary end point. Results From September 2019 to February 2020 (or 7 months), the CDS tool was deployed in the EMR at 4 major hospitals in the University of Maryland Medical System. There were 1269 encounters for cellulitis during the study period. The engagement with the CDS was low (24.1%, 95/394), but engagement was associated with an absolute reduction in admissions (7.1%, p = 0.03). After adjusting for age greater than 65 years, female sex, non‐White race, and private insurance, CDS engagement was associated with a significant reduction of admissions (adjusted OR = 0.62, 95% confidence interval (CI): 0.40–0.97, p = 0.04) and antibiotic use (Adjusted OR = 0.63, 95% CI: 0.40–0.99, p = 0.04). Conclusions CDS engagement was associated with decreased admissions for cellulitis and decreased antibiotic use in this study, despite low levels of CDS engagement. Further research should examine the impact of CDS engagement in other practice environments and measure longer‐term outcomes in patients discharged from the ED.https://doi.org/10.1002/emp2.12969clinical decision supportdermatologyemergency medicinehealth care useinfectious disease |
| spellingShingle | Zachary D.W. Dezman Daniel Lemkin Art Papier Brian Browne The impact of a point‐of‐care visual clinical decision support tool on admissions for cellulitis in the University of Maryland medical system Journal of the American College of Emergency Physicians Open clinical decision support dermatology emergency medicine health care use infectious disease |
| title | The impact of a point‐of‐care visual clinical decision support tool on admissions for cellulitis in the University of Maryland medical system |
| title_full | The impact of a point‐of‐care visual clinical decision support tool on admissions for cellulitis in the University of Maryland medical system |
| title_fullStr | The impact of a point‐of‐care visual clinical decision support tool on admissions for cellulitis in the University of Maryland medical system |
| title_full_unstemmed | The impact of a point‐of‐care visual clinical decision support tool on admissions for cellulitis in the University of Maryland medical system |
| title_short | The impact of a point‐of‐care visual clinical decision support tool on admissions for cellulitis in the University of Maryland medical system |
| title_sort | impact of a point of care visual clinical decision support tool on admissions for cellulitis in the university of maryland medical system |
| topic | clinical decision support dermatology emergency medicine health care use infectious disease |
| url | https://doi.org/10.1002/emp2.12969 |
| work_keys_str_mv | AT zacharydwdezman theimpactofapointofcarevisualclinicaldecisionsupporttoolonadmissionsforcellulitisintheuniversityofmarylandmedicalsystem AT daniellemkin theimpactofapointofcarevisualclinicaldecisionsupporttoolonadmissionsforcellulitisintheuniversityofmarylandmedicalsystem AT artpapier theimpactofapointofcarevisualclinicaldecisionsupporttoolonadmissionsforcellulitisintheuniversityofmarylandmedicalsystem AT brianbrowne theimpactofapointofcarevisualclinicaldecisionsupporttoolonadmissionsforcellulitisintheuniversityofmarylandmedicalsystem AT zacharydwdezman impactofapointofcarevisualclinicaldecisionsupporttoolonadmissionsforcellulitisintheuniversityofmarylandmedicalsystem AT daniellemkin impactofapointofcarevisualclinicaldecisionsupporttoolonadmissionsforcellulitisintheuniversityofmarylandmedicalsystem AT artpapier impactofapointofcarevisualclinicaldecisionsupporttoolonadmissionsforcellulitisintheuniversityofmarylandmedicalsystem AT brianbrowne impactofapointofcarevisualclinicaldecisionsupporttoolonadmissionsforcellulitisintheuniversityofmarylandmedicalsystem |