NDLI: A clinical decision support tool to screen health records for contraindications to stroke thrombolysis

Content Provider	Springer Nature : BioMed Central
Author	Sun, Mu-Chien Chan, Jo-Ann
Abstract	Background The use of intravenous thrombolysis for stroke is limited by contraindications that may be difficult to identify promptly and accurately. Evidence supports the use of information technology-based clinical decision support (CDS) tools to achieve improvements in care delivery. The objective of this pilot study was to investigate the efficacy of a CDS tool to screen health records for contraindications to intravenous stroke thrombolysis. Methods A CDS tool was developed to rapidly screen health information in seven affiliated hospitals for contraindications to stroke thrombolysis. A fixed-sequence, 2-period crossover study was conducted to test the efficacy of the CDS tool. Four mock patient records derived from the stroke registry that contained a total of nine contraindication items in two or more of the hospitals were used for testing purposes. The test patients were preset and balanced between groups with and without the CDS tool appearing six times in each group before recruiting the participating physicians. Physicians who were responsible for thrombolytic therapy and willing to sign informed consent were recruited. The participating physicians were asked to check a list of contraindications for two of the patients by using a shared electronic medical record system among the seven hospitals with and without the CDS tool. The test time and missed contraindications were recorded and analyzed statistically. Results A total of 14 physicians who were responsible for stroke thrombolysis were approached, and 12 signed informed consent and took the test. By using the CDS tool, the test time was reduced significantly from 14.6 ± 7.4 to 7.3 ± 5.2 min (P = 0.010). In a total of 54 contraindications, the number of missed contraindications was reduced significantly from 23 (42.6 %) to seven (13.0 %) (P = 0.001). The difference of missed contraindication number between the two groups was statistically significant either per physician or per contraindication item. Conclusions By screening health records for relevant contraindications, the use of a CDS tool may reduce the time needed to review medical records and reduce the number of missed contraindications for stroke thrombolysis.
Related Links	https://bmcmedinformdecismak.biomedcentral.com/counter/pdf/10.1186/s12911-015-0229-4.pdf
Ending Page	7
Page Count	7
Starting Page	1
File Format	HTM / HTML
ISSN	14726947
DOI	10.1186/s12911-015-0229-4
Journal	BMC Medical Informatics and Decision Making
Issue Number	1
Volume Number	15
Language	English
Publisher	BioMed Central
Publisher Date	2015-12-14
Access Restriction	Open
Subject Keyword	Health Informatics Information Systems and Communication Service Management of Computing and Information Systems Biomedical technology Brain infarction Decision making Computer-assisted Decision support systems Clinical Hospital information systems Medical records systems Computerized Medical informatics Stroke Thrombolytic therapy
Content Type	Text
Resource Type	Article
Subject	Health Informatics Computer Science Applications Health Policy
Journal Impact Factor	3.3/2023
5-Year Journal Impact Factor	3.9/2023

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