Optimizing efficiency of a custom clinical decision support tool improves adult congenital heart disease care.

STUDY OBJECTIVE

Improve the efficiency of an inpatient clinical decision support tool (CDS) for patients with adult congenital heart disease (ACHD).

DESIGN

The efficiency of a CDS was evaluated across two time periods and compared.

SETTING

An academic, tertiary care center.

PARTICIPANTS

ACHD patients roomed in an inpatient setting.

INTERVENTION

Plan-Do-Study-Act (PDSA) methods were applied starting in 2021 and included refinement of diagnostic codes and the addition of department encounter codes.

MAIN OUTCOME MEASURES

True positive and false positive CDS alerts.

RESULTS

Baseline data from 2017 had a median (IQR) of 38 (17) and 2019 baseline data had 65 (19) total alerts per month. Combining both baseline data years, the median true positive CDS alerts was 47.3 %. There were 71 (6) total alerts per month for the 2021-2022 time period and with ongoing PDSA cycles and optimization in the CDS the true positive alerts improved substantially resulting in a shifting of the median to 78.9 % within 9 months.

CONCLUSION

CDS can efficiently notify providers when an ACHD patient is encountered. The use of ICD 10 codes alone to identify ACHD patients has limited accuracy with a high proportion of false positives. Ongoing revision of the CDS system methods is important to improving efficiency and minimizing provider alert fatigue.