The influence of integrating clinical practice guideline order bundles into a general admission order set on guideline adoption

• Type of Material: Article
• Authors: Justine Mrosak, Emory University; Swaminathan Kandaswamy, Emory University; Claire Stokes, Emory University; David Roth, Emory University; Ishaan Dave, Emory University; Scott Gillespie, Emory University; Evan Orenstein, Emory University
• Language: English
• Date: 2021-10-08
• Publisher: Oxford University Press (OUP)
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2021. Published by Oxford University Press on behalf of the American Medical Informatics Association.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/jamiaopen/ooab087
• Title of Journal or Parent Work: JAMIA Open
• Volume: 4
• Issue: 4
• Grant/Funding Information: JM, SK, SG, and ID’s participation was supported by the Emory Department of Pediatrics and Children’s Healthcare of Atlanta through the Warshaw Fellow Research Award Project # 00096666.
• Keywords: user-centered design; clinical practice guidelines; usability testing; clinical decision support
• Research Categories: Health Sciences, Health Care Management

Abstract

Objectives of this study were to (1) describe barriers to using clinical practice guideline (CPG) admission order sets in a pediatric hospital and (2) determine if integrating CPG order bundles into a general admission order set increases adoption of CPG-recommended orders compared to standalone CPG order sets. We identified CPG-eligible encounters and surveyed admitting physicians to understand reasons for not using the associated CPG order set. We then integrated CPG order bundles into a general admission order set and evaluated effectiveness through summative usability testing in a simulated environment. The most common reasons for the nonuse of CPG order sets were lack of awareness or forgetting about the CPG order set. In usability testing, CPG order bundle use increased from 27.8% to 66.6% while antibiotic ordering errors decreased from 62.9% to 18.5% with the new design. Integrating CPG-related order bundles into a general admission order set improves CPG order set use in simulation by addressing the most common barriers to CPG adoption.