Abstract
Background Clinical decision support systems (CDSS) can enhance medical decision-making by providing
targeted information to providers. While they have the potential to improve quality
of care and reduce costs, they are not universally effective and can lead to unintended
harm.
Objectives To describe the implementation of an unsuccessful interruptive CDSS that aimed to
promote appropriate use of intravenous (IV) acetaminophen at an academic pediatric
hospital, with an emphasis on lessons learned.
Methods Quality improvement methodology was used to study the effect of an interruptive CDSS,
which set a mandatory expiry time of 24 hours for all IV acetaminophen orders. This
CDSS was implemented on April 5, 2021. The primary outcome measure was number of IV
acetaminophen administrations per 1,000 patient days, measured pre- and postimplementation.
Process measures were the number of IV acetaminophen orders placed per 1,000 patient
days. Balancing measures were collected via survey data and included provider and
nursing acceptability and unintended consequences of the CDSS.
Results There was no special cause variation in hospital-wide IV acetaminophen administrations
and orders after CDSS implementation, nor when the CDSS was removed. A total of 88
participants completed the survey. Nearly half (40/88) of respondents reported negative
issues with the CDSS, with the majority stating that this affected patient care (39/40).
Respondents cited delays in patient care and reduced efficiency as the most common
negative effects.
Conclusion This study underscores the significance of monitoring CDSS implementations and including
end user acceptability as an outcome measure. Teams should be prepared to modify or
remove CDSS that do not achieve their intended goal or are associated with low end
user acceptability. CDSS holds promise for improving clinical practice, but careful
implementation and ongoing evaluation are crucial for maximizing their benefits and
minimizing potential harm.
Keywords
clinical decision support system - quality improvement - electronic health record
- pediatrics
