Implementation of an Electronic Clinical Decision Support Order Set for Acute Pancreatitis in an Integrated Health Care System: A Mixed Methods Analysis.

BACKGROUND

Standardized admission order entry systems (OES) and clinical decision support (CDS) tools can facilitate implementation of evidence-based practice. We conducted a mixed-methods analysis incorporating quantitative analysis of OES/CDS usage as well as qualitative analysis to identify barriers and facilitators related to usage of acute pancreatitis (AP)-specific OES-CDS.

MATERIALS AND

METHODS

Quantitative analysis: A retrospective cohort study of hospitalized encounters for AP (defined by diagnosis codes and lipase or amylase >3x normal) was conducted across 12 hospitals within an integrated health system from September 2014 through October 2022 to evaluate adoption of the AP OES/CDS, relationship to length-of-stay (LOS≥7 days), and in-hospital mortality adjusted for patient clinical and demographic characteristics. Qualitative analysis: Semistructured interviews of focus groups identified themes related to perceived benefits, barriers, and improvements to the OES/CDS.

RESULTS

Among 16,874 AP hospitalizations during the study, annual use of the AP OES/CDS peaked in 2021 at 7.4%. Use of AP OES/CDS was associated with reduction in prolonged LOS (OR: 0.81, 95% CI: 0.69-0.94). This finding was consistent after adjusting age, sex, race/ethnicity, and comorbidity indices. No significant difference in mortality was associated with OES usage (OR: 0.89, 95% CI: 0.61-1.32). Barriers to OES adoption included lack of awareness, competition with other tools, and complexity of patient case-mix.

CONCLUSION

Although adoption was limited, usage of an AP OES/CDS tool was associated with a decrease in prolonged length-of-stay. Future efforts to expand the reach of such instruments through provider awareness and refinement of the instrument may facilitate broader impact for management of patients with acute pancreatitis.