Utilizing Clinical Decision Support Within the Electronic Health Record to Screen for Palliative Care

2.50
Hdl Handle:
http://hdl.handle.net/10755/621963
Category:
Full-text
Format:
Text-based Document
Type:
Presentation
Level of Evidence:
N/A
Research Approach:
N/A
Title:
Utilizing Clinical Decision Support Within the Electronic Health Record to Screen for Palliative Care
Other Titles:
Technologies to Influence Palliative Care
Author(s):
Baum, Tanja; Bush, Ruth A.; Etland, Caroline; Connelly, Cynthia D.
Lead Author STTI Affiliation:
Zeta Mu-at-Large
Author Details:
Tanja Baum, PhD, RN, Professional Experience: 08/2011-11/2013 Critical Care Registered Nurse, Whittier Hospital, Whittier, CA 06/2013-present Critical Care Registered Nurse, PIH Health, Whittier, CA 08/2016-present Clinical Faculty, Hahn School of Nursing and Health Science, Universtity of San Diego Author Summary: Ms. Baum's research interest are focused on patient-centered outcomes given her professional background in critical care. As a new researcher she had the opportunity to work with experienced researchers and multi-disciplinary teams across populations. These populations include but are not limited to third world country, maternity, end-of-life, as well as adult critically ill patients.
Abstract:

Purpose:

Timelier referral to palliative care services (PCS) within the acute care setting is a health care priority. End-of-life consumes a disproportionate share of healthcare dollars with studies indicating PCS can save hospitals approximately $1.3 million annually, for every 500 consults completed. Strategies to increase timelier referral are needed. Integration of electronic clinical decision support and utilization of triggers to identify individuals who may benefit from palliative care, using an algorithm embedded with the electronic health record (EHR) may facilitate this identification, but lacks empirical support.

The purpose of this research was to utilize variables available in the electronic healthcare record (EHR) of palliative care patients receiving PCS in the acute care setting to identify triggers which could be used to identify individuals who should be referred for PCS.

Specific Aims:

Aim 1: Characterize EHR data related to palliative care consultations among severely and chronically ill patients in the acute care.

Aim 2: Examine the relationships between the list of clinical EHR data, select demographics, in a sample of palliative care patients

Methods:

A descriptive, correlational study using de-identified retrospective data, collected from January 1, 2013 to December 31, 2015. An institutionally derived list of variables was used to provide a foundation for clinical decision support and patient identification integrated into the Cerner EHR system. Data were derived from three hospitals of a large multi-community healthcare system in San Diego County. Descriptive and inferential statistical analyses conducted using SPSS version 23.

Results:

A randomized sample yielded 694 palliative care patients seeking acute care treatment at one of the three hospitals. Of these 51.7% were male, 65.4% White, 36.7% Christian, 80.8% English speaking, 49.7% Medicare recipients, 51.4% declared themselves as a ‘do-not-resuscitate’ and 97.6% were seen by a palliative care nurse. Significant associations were found between race/ethnicity/code status (X2 = 11.311, p .02), language/presence of advance directive (X2 = 13.845, p .008), and change of code status/loss of responsiveness (X2 =15.129, p<.001).

Conclusion:

Using a large sample, a number of statistically significant demographic, physiologic, and clinical variables were found that to identify individuals suitable for timely referral to palliative care services. The integration of an EHR-based trigger system can aid not only nursing, but the interdisciplinary team to identify and refer potential palliative care patients in a timelier manner. The findings lay an important foundation for increased refinement of electronic clinical decision support within the EHR.

Keywords:
acute care; clinical decision support; palliative care
Repository Posting Date:
19-Jul-2017
Date of Publication:
19-Jul-2017
Other Identifiers:
INRC17P16
Conference Date:
2017
Conference Name:
28th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International
Conference Location:
Dublin, Ireland
Description:
Event Theme: Influencing Global Health Through the Advancement of Nursing Scholarship

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePresentationen
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titleUtilizing Clinical Decision Support Within the Electronic Health Record to Screen for Palliative Careen_US
dc.title.alternativeTechnologies to Influence Palliative Careen
dc.contributor.authorBaum, Tanjaen
dc.contributor.authorBush, Ruth A.en
dc.contributor.authorEtland, Carolineen
dc.contributor.authorConnelly, Cynthia D.en
dc.contributor.departmentZeta Mu-at-Largeen
dc.author.detailsTanja Baum, PhD, RN, Professional Experience: 08/2011-11/2013 Critical Care Registered Nurse, Whittier Hospital, Whittier, CA 06/2013-present Critical Care Registered Nurse, PIH Health, Whittier, CA 08/2016-present Clinical Faculty, Hahn School of Nursing and Health Science, Universtity of San Diego Author Summary: Ms. Baum's research interest are focused on patient-centered outcomes given her professional background in critical care. As a new researcher she had the opportunity to work with experienced researchers and multi-disciplinary teams across populations. These populations include but are not limited to third world country, maternity, end-of-life, as well as adult critically ill patients.en
dc.identifier.urihttp://hdl.handle.net/10755/621963-
dc.description.abstract<p><strong>Purpose:</strong></p> <p>Timelier referral to palliative care services (PCS) within the acute care setting is a health care priority. End-of-life consumes a disproportionate share of healthcare dollars with studies indicating PCS can save hospitals approximately $1.3 million annually, for every 500 consults completed. Strategies to increase timelier referral are needed. Integration of electronic clinical decision support and utilization of triggers to identify individuals who may benefit from palliative care, using an algorithm embedded with the electronic health record (EHR) may facilitate this identification, but lacks empirical support.</p> <p>The purpose of this research was to utilize variables available in the electronic healthcare record (EHR) of palliative care patients receiving PCS in the acute care setting to identify triggers which could be used to identify individuals who should be referred for PCS.</p> <p>Specific Aims:</p> <p>Aim 1: Characterize EHR data related to palliative care consultations among severely and chronically ill patients in the acute care.</p> <p>Aim 2: Examine the relationships between the list of clinical EHR data, select demographics, in a sample of palliative care patients</p> <p><strong>Methods:</strong></p> <p>A descriptive, correlational study using de-identified retrospective data, collected from January 1, 2013 to December 31, 2015. An institutionally derived list of variables was used to provide a foundation for clinical decision support and patient identification integrated into the Cerner EHR system. Data were derived from three hospitals of a large multi-community healthcare system in San Diego County. Descriptive and inferential statistical analyses conducted using SPSS version 23.</p> <p><strong>Results:</strong></p> <p>A randomized sample yielded 694 palliative care patients seeking acute care treatment at one of the three hospitals. Of these 51.7% were male, 65.4% White, 36.7% Christian, 80.8% English speaking, 49.7% Medicare recipients, 51.4% declared themselves as a ‘do-not-resuscitate’ and 97.6% were seen by a palliative care nurse. Significant associations were found between race/ethnicity/code status (X<sup>2</sup> = 11.311, p .02), language/presence of advance directive (X<sup>2</sup> = 13.845, p .008), and change of code status/loss of responsiveness (X<sup>2</sup> =15.129, p<.001).</p> <p><strong>Conclusion:</strong></p> <p>Using a large sample, a number of statistically significant demographic, physiologic, and clinical variables were found that to identify individuals suitable for timely referral to palliative care services. The integration of an EHR-based trigger system can aid not only nursing, but the interdisciplinary team to identify and refer potential palliative care patients in a timelier manner. The findings lay an important foundation for increased refinement of electronic clinical decision support within the EHR.</p>en
dc.subjectacute careen
dc.subjectclinical decision supporten
dc.subjectpalliative careen
dc.date.available2017-07-19T21:07:42Z-
dc.date.issued2017-07-19-
dc.date.accessioned2017-07-19T21:07:42Z-
dc.conference.date2017en
dc.conference.name28th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau Internationalen
dc.conference.locationDublin, Irelanden
dc.descriptionEvent Theme: Influencing Global Health Through the Advancement of Nursing Scholarshipen
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