Hoff Brian M, Ford Diana C, Ince Dilek, Ernst Erika J, Livorsi Daniel J, Heintz Brett H, Masse Vincent, Brownlee Michael J, Ford Bradley A
Department of Pharmaceutical Care, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Department of Internal Medicine, Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
J Pathol Inform. 2018 Apr 2;9:10. doi: 10.4103/jpi.jpi_77_17. eCollection 2018.
Medical applications for mobile devices allow clinicians to leverage microbiological data and standardized guidelines to treat patients with infectious diseases. We report the implementation of a mobile clinical decision support (CDS) application to augment local antimicrobial stewardship.
We detail the implementation of our mobile CDS application over 20 months. Application utilization data were collected and evaluated using descriptive statistics to quantify the impact of our implementation.
Project initiation focused on engaging key stakeholders, developing a business case, and selecting a mobile platform. The preimplementation phase included content development, creation of a pathway for content approval within the hospital committee structure, engaging clinical leaders, and formatting the first version of the guide. Implementation involved a media campaign, staff education, and integration within the electronic medical record and hospital mobile devices. The postimplementation phase required ongoing quality improvement, revision of outdated content, and repeated staff education. The evaluation phase included a guide utilization analysis, reporting to hospital leadership, and sustainability and innovation planning. The mobile application was downloaded 3056 times and accessed 9259 times during the study period. The companion web viewer was accessed 8214 times.
Successful implementation of a customizable mobile CDS tool enabled our team to expand beyond microbiological data to clinical diagnosis, treatment, and antimicrobial stewardship, broadening our influence on antimicrobial prescribing and incorporating utilization data to inspire new quality and safety initiatives. Further studies are needed to assess the impact on antimicrobial utilization, infection control measures, and patient care outcomes.
移动设备的医学应用使临床医生能够利用微生物学数据和标准化指南来治疗传染病患者。我们报告了一种移动临床决策支持（CDS）应用程序的实施情况，以加强当地的抗菌药物管理。
我们详细介绍了我们的移动CDS应用程序在20个月内的实施情况。收集应用程序使用数据，并使用描述性统计进行评估，以量化我们实施的影响。
项目启动重点是吸引关键利益相关者、制定商业案例和选择移动平台。实施前阶段包括内容开发、在医院委员会结构内创建内容批准途径、与临床领导者合作以及格式化指南的第一版。实施涉及媒体宣传、员工教育以及与电子病历和医院移动设备的集成。实施后阶段需要持续的质量改进、修订过时内容以及重复的员工教育。评估阶段包括指南使用分析、向医院领导汇报以及可持续性和创新规划。在研究期间，移动应用程序被下载3056次，访问9259次。配套的网络查看器被访问8214次。
成功实施可定制的移动CDS工具使我们的团队能够从微生物学数据扩展到临床诊断、治疗和抗菌药物管理，扩大了我们对抗菌药物处方的影响，并纳入使用数据以激发新的质量和安全举措。需要进一步研究来评估对抗菌药物使用、感染控制措施和患者护理结果的影响。
