• Virginia Maina

ULIZA-JIBU-TIBU: Clinical Decision Support

Clinical decision-making process in a medical setting is complex, dynamic, under time pressure and often with serious consequences for a patient’s condition.1 Consequences from clinical decision making include diagnostic errors and studies have shown that communication strategies have been cited as a means to evaluate healthcare clinical performance, reduce diagnostic errors and improve quality of patient care.

Hence, clinical decision support systems are quickly becoming essential tools for healthcare providers.


Clinical Decision Support (CDS) is any tool that provides clinicians, administrative staff, patients, caregivers, or other members of the care team with information that is filtered or targeted to a specific person or situation. 

CDS is intended to improve care quality, avoid errors or adverse events and allow care team members to be more efficient.2


“The amount of information we need to understand is getting so untenable that it’s unreasonable to expect the average clinician to integrate all of it into their decision-making effectively and reliably,” said Dr. Joe Kimura, Chief Medical Officer at Atrius Health.''


Clinical Decision support systems are quickly becoming essential tools for health facilities as the volume of available data increases alongside their responsibility to deliver value-based care. A CDS system has the following benefits;

  • Increased quality of care and enhanced health outcomes

  • Avoidance of errors and adverse events and

  • Improved efficiency, cost-benefit, and provider and patient satisfaction.3

To successfully Implement a Clinical Decision support system health facilities should consider;

A collaborative approach-Physicians, nurses, administrators, and other technology users should be part of the discussion when identifying promising use cases and considering CDS vendors or implementation strategies.

Tapping clinical champions, including members of the nursing staff, could help to create a more receptive environment while developing a feedback pipeline to inform future efforts.

Effective clinical champions are tech-savvy members of the organization who are trusted by their peers, understand the technical and workflow challenges of their colleagues, can provide a balanced and informed perspective, and have strong interpersonal skills that can help them handle conflict, skepticism, or frustration.


CDS tools are often integrated into the electronic health record (EHR) to streamline workflows and take advantage of existing data sets.


Conclusion

Diagnostic errors are responsible for a significant number of adverse events. Clinical decision support can significantly impact improvements in quality, safety, efficiency, and effectiveness of health care.4

Sometimes, despite what the evidence-based-medicine enthusiasts might have you believe, your best decision-making resources are not books or computer programs but rather the physicians you practice with. Not only do they have a wealth of knowledge about clinical medicine, but they also know the same patient population that you know. No textbook can help you with the probabilities and epidemiology of your unique patient population, but your colleagues certainly can.5



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References

1. Hausmann, D., Zulian, C., Battegay, E. et al. Tracing the decision-making process of physicians with a Decision Process Matrix. BMC Med Inform Decis Mak16, 133 (2016). https://doi.org/10.1186/s12911-016-0369-1

2. Health IT Analytics

3. Tcheng, J. E., S. Bakken, D. W. Bates, H. Bonner III, T. K. Gandhi, M. Josephs, K. Kawamoto, E. A. Lomotan, E. Mackay, B. Middleton, J. M. Teich, S. Weingarten, and M. Hamilton Lopez, editors. 2017. Optimizing Strategies for Clinical Decision Support: Summary of a Meeting Series. Washington, DC: National Academy of Medicine.

4. Trimble, M., & Hamilton, P. (2016). The thinking doctor: clinical decision making in contemporary medicine. Clinical medicine (London, England), 16(4), 343–346. https://doi.org/10.7861/clinmedicine.16-4-343

5. FPM Journal: The Art and Science of Clinical Decision Making






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