CDS implementation improves guideline adherence for head CT in ED

The implementation of clinical decision support systems (CDS) in the emergency department (ED) has been shown to improve adherence to guidelines for head CT, according to a study published online Feb. 17 by the Journal of the American Medical Informatics Association.

A majority of the patients presenting to the ED with mild traumatic brain injuries undergo head CT. CDS that is integrated with computerized provider order entry has been proven to decrease utilization and improve the yield of head CT in the ED, leading to a federal mandate of its adoption. Lead author Anurag Gupta, MD, MBA, of Brigham and Women’s Hosptial in Boston, and colleagues sought to determine the impact of an electronic CDS tool designed to guide emergency decision-making regarding use of head CT for patients with mild traumatic brain injury.

The researchers evaluated the 27 months prior to and following the month when a CDS tool was implemented in a Level 1 trauma center. A random sample of 200 head CTs on patients with mild traumatic brain injury was collected from each of the baseline and intervention periods.

Results demonstrated that at baseline, document guided adherence was 49 percent. Once the CDS tool was implemented, adherence increased to 76.5 percent. Thus, a 56 percent relative increase in adherence to evidence-based guidelines was demonstrated with the use of a clinical decision tool.

“The CDS tool also provided an efficient, unambiguous method for retrieving the data needed to compute adherence performance metrics, which can support iterative quality improvement projects. However, even after CDS implementation, one-fourth of CTs in ED patients with MTBI remained inconsistent with evidence, suggesting that further opportunities for performance improvement remain,” wrote the study’s authors.