Tailoring clinical decision support for rural hospitals: A qualitative pilot study of accessing infectious disease expertise for Staphylococcus aureus bacteremia.

BACKGROUND

Clinical decision support tools (ie, electronic alerts) can improve outcomes for patients with Staphylococcus aureus bacteremia (SAB) in hospitals with on-site infectious disease (ID) specialists. However, many rural hospitals lack on-site ID consultants and/or electronic health record (EHR) interoperability, presenting challenges for SAB patient care.

METHODS

We conducted qualitative interviews with rural hospital employees about SAB management processes and needs and elicited feedback on an EHR alert used at a large urban hospital with on-site ID specialists. We used a rapid qualitative inquiry process to identify interview themes.

RESULTS

Rural hospitals had wide variation in existing availability of ID consultations and processes for seeking consultations. Participants provided suggestions for tailoring and implementing an electronic alert encouraging ID consultation within rural hospital work systems.

DISCUSSION: Increasing ID consultations, including through EHR alerts in rural hospitals, has many barriers. An EHR alert providing first-line guidance on urgency, therapy, and communication may support guideline-concordant care for SAB within the unique workflows of smaller and more rural hospitals.

CONCLUSIONS

Electronic alerts, while useful in hospitals with on-site ID specialists to encourage ID consultations, will need to be tailored and implemented in rural hospitals to achieve similar clinical decision support results.