Anesthesiology, Stanford University School of Medicine, Stanford, California, USA
Anesthesiology, Stanford University School of Medicine, Stanford, California, USA.
BMJ Open Qual. 2023 Oct;12(4). doi: 10.1136/bmjoq-2022-002240.
Monitoring complications associated with medical procedures requires reliable and accurate record keeping. Nudge reminders executed by way of electronic medical record (EMR) alerts influence clinician behaviour. We hypothesised that the introduction of an EMR nudge would improve documentation of replaced neuraxial blocks by obstetric anaesthesiologists at our institution.
We developed an EMR nudge that would alert the physician to a replaced neuraxial block if two or more neuraxial procedure notes in a single patient encounter were detected. The nudge encouraged physicians to document neuraxial block replacements in our institution's quality improvement database. We assessed the rate of physician adherence to replaced neuraxial block charting prior to the introduction of the nudge (January 2019-September 2019) and after the implementation (October 2019-December 2020).
494 encounters during the chart review period, January 2019-December 2020, required a neuraxial block replacement, representing an actual neuraxial replacement rate of 6.3% prior to the introduction of the nudge in October 2019. This rate was largely unchanged (6.2%) after the introduction of the nudge (0.1% difference, 95% CI: -0.0119 to 0.0099). Prior to the introduction of the nudge, the proportion of correctly charted failed/replaced blocks in our quality improvement database was 80.0%, and after nudge introduction, the rate was 96.2% (p value <0.00001, OR=6.32, 95% CI: 3.15 to 12.66). A p-chart of the monthly adherence rate demonstrated sustained improvement over time.
EMR nudge technology significantly improved adherence with quality metric monitoring of neuraxial catheter replacement in obstetric patients. The results imply that data collection for quality metric databases of neuraxial block failures and replacements that rely on clinician memory without a nudge are likely under-reporting neuraxial block failures and replacements. This study supports widespread implementation of nudges in EMRs to improve quality metric reporting.
监测与医疗程序相关的并发症需要可靠和准确的记录保存。通过电子病历 (EMR) 提醒执行的轻推会影响临床医生的行为。我们假设在我们的机构中引入 EMR 轻推会改善产科麻醉师对更换的椎管内阻滞的记录。
我们开发了一种 EMR 轻推，如果在单个患者就诊中检测到两个或更多的椎管内程序记录，它将提醒医生注意更换的椎管内阻滞。该轻推鼓励医生在我们机构的质量改进数据库中记录椎管内阻滞更换。我们评估了在引入轻推之前 (2019 年 1 月至 2019 年 9 月) 和引入之后 (2019 年 10 月至 2020 年 12 月) 医生对更换的椎管内阻滞图表记录的依从率。
在审查期间，2019 年 1 月至 2020 年 12 月，有 494 次就诊需要更换椎管内阻滞，这代表在 2019 年 10 月引入轻推之前，实际的椎管内更换率为 6.3%。引入轻推后，这一比率基本保持不变 (6.2%，差异为 0.1%，95%CI：-0.0119 至 0.0099)。在引入轻推之前，我们的质量改进数据库中正确记录的失败/更换的阻滞比例为 80.0%，引入轻推后，该比例为 96.2%（p 值<0.00001，OR=6.32，95%CI：3.15 至 12.66）。每月依从率的 p 图显示出随着时间的推移持续改善。
EMR 轻推技术显著提高了产科患者椎管内导管更换的质量指标监测的依从性。结果表明，不使用轻推依靠临床医生记忆来收集椎管内阻滞失败和更换的质量指标数据库的数据可能会少报椎管内阻滞失败和更换。这项研究支持在 EMR 中广泛实施轻推以改善质量指标报告。
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