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A Retrospective Analysis of Interruptive versus Non-interruptive Clinical Decision Support for Identification of Patients Needing Contact Isolation

Journal: Applied Clinical Informatics
ISSN: 1869-0327
DOI: http://dx.doi.org/10.4338/ACI-2013-04-RA-0021
Issue: Vol. 4: Issue 4 2013
Pages: 569-582

A Retrospective Analysis of Interruptive versus Non-interruptive Clinical Decision Support for Identification of Patients Needing Contact Isolation

Research Article

J. M. Pevnick (1, 2), X. Li (1), J. Grein (2, 3), D. S. Bell (4, 5), P. Silka (1, 6)

(1) Enterprise Information Services, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048 (JMP, XL, PS); (2) Department of Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048 (JMP, JG); (3) Department of Epidemiology, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048 (JG); (4) RAND Health, 1776 Main Street, Santa Monica, CA 90401 (DB); (5) David Geffen School of Medicine, Division of General Internal Medicine and Health Services Research, BOX 951736, 911 Broxton Plz, Los Angeles, CA 90095 (DB); (6) Department of Emergency Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048 (PS)

Keywords

Infection Control, Computer-assisted Decision Making, Clinical decision support systems

Summary

Background: In determining whether clinical decision support (CDS) should be interruptive or non-interruptive, CDS designers need more guidance to balance the potential for interruptive CDS to overburden clinicians and the potential for non-interruptive CDS to be overlooked by clinicians.

Objectives: (1)To compare performance achieved by clinicians using interruptive CDS versus using similar, non-interruptive CDS. (2)To compare performance achieved using non-interruptive CDS among clinicians exposed to interruptive CDS versus clinicians not exposed to interruptive CDS.

Methods: We studied 42 emergency medicine physicians working in a large hospital where an interruptive CDS to help identify patients requiring contact isolation was replaced by a similar, but non-interruptive CDS. The first primary outcome was the change in sensitivity in identifying these patients associated with the conversion from an interruptive to a non-interruptive CDS. The second primary outcome was the difference in sensitivities yielded by the non-interruptive CDS when used by providers who had and who had not been exposed to the interruptive CDS. The reference standard was an epidemiologist-designed, structured, objective assessment.

Results: In identifying patients needing contact isolation, the interruptive CDS-physician dyad had sensitivity of 24% (95% CI: 17%-32%), versus sensitivity of 14% (95% CI: 9%-21%) for the non-interruptive CDS-physician dyad (p = 0.04). Users of the non-interruptive CDS with prior exposure to the interruptive CDS were more sensitive than those without exposure (14% [95% CI: 9%-21%] versus 7% [95% CI: 3%-13%], p = 0.05).

Limitations: As with all observational studies, we cannot confirm that our analysis controlled for every important difference between time periods and physician groups.

Conclusions: Interruptive CDS affected clinicians more than non-interruptive CDS. Designers of CDS might explicitly weigh the benefits of interruptive CDS versus its associated increased clinician burden. Further research should study longer term effects of clinician exposure to interruptive CDS, including whether it may improve clinician performance when using a similar, subsequent non-interruptive CDS.

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