Impact of a clinical decision support tool on adherence to the Ottawa Ankle Rules

• Published in: The American journal of emergency medicine Vol. 34; no. 3; pp. 412 - 418
• Main Authors: Silveira, Patricia C., MD, Ip, Ivan K., MD, MPH, Sumption, Siobhan, BSc, Raja, Ali S., MD, MPH, MBA, Tajmir, Shahein, MD, Khorasani, Ramin, MD, MPH
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2016; Elsevier Limited
• Subjects: Accountability; Adult; Ankle; Ankle Injuries - diagnostic imaging; Bones; Data collection; Decision making; Decision Support Systems, Clinical; Documentation; Emergency; Emergency medical care; Emergency medical services; Emergency Service, Hospital; Female; Guideline Adherence; Health care policy; Health Insurance Portability & Accountability Act 1996-US; Hospitals; Humans; Information technology; Injuries; Male; Medicare; Pain; Physicians; Practice Patterns, Physicians' - statistics & numerical data; Radiography; Review boards; United States > US
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2015.11.028

Abstract Objective The objective of the study is to determine impact of a clinical decision support (CDS) tool on documented adherence to the Ottawa Ankle Rules (OAR) and utilization and yield of ankle/foot radiography, for emergency department patients with acute ankle injury. Methods This is a before-and-after intervention study conducted at a 793-bed, quaternary care, academic hospital from August 2012 to October 2013. Emergency department visits from adults with acute ankle injury 6 months before and 8 months after the intervention were included. The intervention embedded the OAR into a CDS tool integrated with a computerized physician order entry system, which had data capture capability and provided feedback at the time of ankle/foot radiography order. Primary outcome was rate of documented adherence to OAR. Secondary outcomes were utilization and yield (clinically significant fracture rates among patients with acute ankle injuries) of ankle/foot radiography. Results The study population included 460 visits; 205 (44.6%) occurred preintervention. After intervention, documented OAR adherence increased from 55.9% (229/410) to 95.7% (488/510; P < .001). Utilization remained stable for ankle (77.5%; P = .800) and foot (48.6%; P = .514) radiography. Yield remained stable for ankle (17.8%; P = .891) and foot (19.8%; P = .889) radiography. Discussion Lack of documentation of key clinical data may hamper provider communication, delay care coordination, and result in legal liability. By embedding the OAR into a CDS tool, we achieved the same rate of documented adherence as previous onerous educational implementations while automating data collection/retrieval. In summary, implementation of the OAR into a CDS tool was associated with an increase in documented adherence to the OAR.