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A quantitative study investigating the effects of computerised clinical decision support in the emergency department

Bennett, P 2014, A quantitative study investigating the effects of computerised clinical decision support in the emergency department , DProf thesis, University of Salford.

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Abstract

Introduction: Over the last decade there has been a significant increase in the use of computerised clinical decision support systems (CCDSS) in health care. While significant research has been carried out to demonstrate the impact of CCDSS, the role of CCDSSs in Emergency Departments (EDs) remains under-investigated. The aim of this study was to investigate if the introduction of a CCDSS at ED triage, improved the quality and safety of decisions at triage and improved overall departmental safety. Methods: This study adopted an interrupted time series design, with 8 time points. A random sample of triage records (n=400) from the year before the introduction of eTriage (four time points) were compared to the same number of records from the year after its introduction. Data was extracted from ED clinical records to establish the accuracy of triage prioritisation as an indicator of safety and the management of pain as an indicator of quality. A smaller subset of cases (n=44) over the same time period were analysed to assess any differences in the clinical management of patients presenting with neutropenic sepsis, a further indicator of safety. Logistic regression analysis was undertaken to expose the underlying decision-making trend over the whole study period. Results: This study demonstrates a statistically significant improvement in triage prioritisation (p<0.001), pain scoring (p<0.001) and pain management (p<0.001). Logistic regression demonstrated improvements in decision-making above what have been expected if eTriage had not been introduced. For patients presenting with neutropenic sepsis there was no statistically significant difference in their clinical management. Conclusion: This study clearly demonstrated the positive impact that a CCDSS can have on the quality and safety for ED patients and provides a unique contribution of the current ED CCDSS knowledge base. The ever-increasing demand for emergency care and the difficulties in recruiting an experienced workforce is a fertile environment for clinicians to harness the potential that technological solutions can offer.

Item Type: Thesis (DProf)
Themes: Health and Wellbeing
Schools: Schools > School of Nursing, Midwifery, Social Work & Social Sciences
Funders: Non funded research
Depositing User: PE Bennett
Date Deposited: 03 Feb 2015 12:59
Last Modified: 05 Apr 2016 18:18
URI: http://usir.salford.ac.uk/id/eprint/32934

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