Diagnostic omission errors in acute paediatric practice: impact of a reminder system on decision-making

• HIT Description: Decision support More info...
  
• Purpose of Study: Measure the impact of "Isabel", a diagnostic decision support system, on the quality of clinical decisions made by house officers/junior doctors for pediatric patients presenting with an acute complaint
  
• Years of study: 2002-2003
  
• Study Design: Pre-post
  
• Outcomes: impact on health care effectiveness and quality
  

• Settings: all children presenting to a Pediatric Assessment Area/Ambulatory Unit associated with 2 university-affilieated and 2 non-university affiliated district general hospitals outside London who were evaluated by a junior doctor
• Intervention: Within-subject "before" and "after" evaluation in which each study subject acted as their own control. Junior doctors accessed the decision support system whre they entered patient clinical details and their own diagnostic work-up and plans and were subsequently presented with diagnostic suggestions with the choice to revise their original work-up
• Evaluation Method: data obtained from the decision support system was validated using medical record reviewand review of discharge diagnoses and summaries; physician questionnaire
• Description: Web-based, free standing diagnostic decision support system that matches clinical features outlined using natural language free text data entry to disease descriptions included in the system's database
• Interoperability: Trial version accessible only via a designated shortcut icon placed on each study computer
• Strategy: Three group training sessions occurred one month before study start date and repeated twice during the study period
• Barriers: May have been instances when physicians were unable to access the system because of technical problems; trial website cumbersome to use
• Quality of Care and Patient Safety Outcome: Reduced "unsafe" work-ups by 12.5%�