Improving adherence to asthma clinical guidelines and discharge documentation from emergency departments: Implementation of a dynamic and integrated electronic decision support system

Objective:  The authors previously developed a dynamic and integrated electronic decision support system called ACAFE (Asthma Clinical Assessment Form and Electronic decision support). The objective of this present study was to evaluate the effectiveness of this system on asthma management and docum...

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Bibliographic Details
Published in:Emergency medicine Australasia 2009-02, Vol.21 (1), p.31-37
Main Authors: Kwok, Raymond, Dinh, Michael, Dinh, David, Chu, Matthew
Format: Article
Language:English
Subjects:
Adolescent
Adult
asthma
Asthma - therapy
clinical guidelines
Clinical Protocols
decision support
Decision Support Systems, Clinical - instrumentation
Documentation - standards
emergency department
Emergency Service, Hospital - standards
Female
Guideline Adherence - statistics & numerical data
Guidelines as Topic
Humans
Logistic Models
Male
New South Wales
Odds Ratio
Outcome and Process Assessment (Health Care)
Patient Discharge - standards
Young Adult
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Summary:Objective:  The authors previously developed a dynamic and integrated electronic decision support system called ACAFE (Asthma Clinical Assessment Form and Electronic decision support). The objective of this present study was to evaluate the effectiveness of this system on asthma management and documentation in an ED. Method:  Observational study using a pre‐ and post‐intervention design, comparing patients managed using ACAFE after its implementation with historical controls. A systematic data ion process was used to compare patient records. Results:  A total of 50 patients were enrolled in the study group. These were compared with 50 historical controls. Use of ACAFE was associated with significantly higher rates of documentation of asthma severity (98% vs 18%, P < 0.01), as well as other clinically important variables, such as asthma precipitants, intensive care admission history and smoking history. ACAFE was also associated with significantly higher rate of asthma discharge plan documentation (76% vs 16%, P < 0.01), and this remained significant after adjustment for triage category and seniority of treating doctor in a regression model. Conclusion:  The use of this decision support system in patients presenting to emergency with asthma was associated with improvements in clinical documentation and discharge management plans. Electronic decision support systems developed collaboratively with clinicians should play an important part of system‐wide efforts to improve guideline adherence and compliance in ED.
ISSN:1742-6731
1742-6723
DOI:10.1111/j.1742-6723.2008.01149.x