Methods Design

1. Impact of an Intranet-based Decision Support Tool on Adherence to a Therapist Driven Protocol Christopher B. Teegardin RRT Harborview Medical Center Seattle, Washington • Results • Phase 1 • Practitioner adherence to the IDST recommendations in the pre-IDST group could not be determined due to inadequate data. • Practitioner adherence to the IDST recommendation was 67% (154/229 BHP evaluations) in the post-IDST group with the practitioner providing the recommended intervention or more than the recommended intervention 90% (206/229 BHP evaluations) of the time. • Phase 2 • Practitioner adherence to the IDST recommendation was 81% (574/701BHP evaluations) with the practitioner providing the recommended intervention or more than the recommended intervention 93% (655/701 BHP evaluations) of the time. Abstract BACKGROUND: Aggregated data collected on Bronchial Hygiene Protocol (BHP) patients from an Electronic Medical Record (EMR) and a sample of chart reviews was inadequate to quantify protocol adherence and its effect on patient outcome. By converting the BHP decision tree flowchart into an Intranet-based Decision Support Tool (IDST), it was hypothesized the additional data collected would improve discovery and interpretation of protocol adherence issues, ultimately improving protocol adherence by staff. METHOD: The IDST is designed as an online questionnaire. Like questions based on patient presentation are grouped together with a yes or no response provided. Each response leads down a different path of questions until an endpoint with a recommended intervention is reached. The IDST is completed at initiation of the BHP and every BHP reevaluation prior to editing the Electronic Medical Record (EMR) of the patient. The IDST requires completion if 48 hours has elapsed after the last BHP reevaluation. The study was carried out in 2 phases. In Phase 1, a retrospective chart review of 58 BHP patients and a database review of 71 BHP patients prior to implementation of the IDST (pre-IDST) were compared to a retrospective chart review of 20 BHP patients and a database review of 88 BHP patients compiled over the two months after implementation of the IDST (post-IDST). In Phase 2, a database review of 249 BHP patients between months 3 and 8 following implementation of the IDST (end-IDST) was carried out to examine the effect of changes to the IDST performed due to the findings in Phase 1. RESULTS: In Phase 1, Practitioner adherence to the IDST recommendations in the pre-IDST group could not be determined due to inadequate data. Practitioner adherence to the IDST recommendation was 67% (154/229 BHP evaluations) in the post-IDST group with the practitioner providing the recommended intervention or more than the recommended intervention 90% (206/229 BHP evaluations) of the time. Following implementation of changes in response to the post-IDST data, Phase 2 indicated practitioner adherence to the IDST recommendation was 81% (574/701BHP evaluations) with the practitioner providing the recommended intervention or more than the recommended intervention 93% (655/701 BHP evaluations) of the time. CONCLUSION: An IDST provides an effective quality assurance mechanism to discover, interpret, and address issues that impact adherence to therapist driven protocols. Introduction The Bronchial Hygiene Protocol (BHP) is a therapist driven protocol that manages the ward patient requiring respiratory intervention for secretion management and/or hyperinflation therapy. Appropriate intervention is determined by applying a clinical assessment of the patient to a decision tree flowchart. Protocol adherence is vital to insure that appropriate and effective patient care is provided. In addition, methods to investigate how a protocol is implemented and followed are key to improving the protocol and its use by the practitioner. Aggregated data collected on BHP patients from an Electronic Medical Record (EMR) database in the respiratory care department, and from a sample of chart reviews of BHP patients, was inadequate to quantify protocol adherence, effect on patient outcome, or cost-effectiveness of care. By converting the BHP decision tree flowchart into an Intranet-based Decision Support Tool (IDST), it was hypothesized that the additional data collected would provide a mechanism to discover, interpret, and address protocol adherence issues and ultimately lead to improved protocol adherence by staff. • Methods • Design • The IDST (see Figure 1) is designed as an online questionnaire. Like questions based on patient presentation are grouped together with a yes or no response provided. Each response leads to a different path of questions until an endpoint with a recommended treatment is reached as identified on the BHP decision tree flowchart (see Figure 2). • The IDST is completed at initiation of the BHP and every BHP reevaluation prior to editing the EMP of the patient. The IDST requires completion every 48 hours. • Phase 1 • A retrospective chart review of 58 BHP patients and a database review of 71 BHP patients prior to implementation of the IDST (pre-IDST) were compared to a retrospective chart review of 20 BHP patients and a database review of 88 BHP patients compiled over the two months after implementation of the IDST (post-IDST). • Based on the data collected, decision point questions within the IDST were redesigned to narrow interpretation and response. • Phase 2 • A database review of 249 BHP patients between months 3 and 8 following implementation of the IDST (end-IDST) was carried out to examine the effect of the changes to the IDST performed in Phase 1. Table 1: Comparison of the post-IDST and end-IDST protocol adherence. Chi-square test p<0.01 Conclusion The inclusion of an Intranet-based Decision Support Tool in conjunction with an Electronic Medical Record system provides an effective mechanism for collecting data to discover, interpret, and address issues that can adversely impact adherence to therapist driven protocols. Acknowledgements Disclosure of presenter conflict(s) of interest – none Disclosure of any research funding, sponsorship, or financial support – none For further information Please contact Christopher Teegardin at email address: cbtee@u.washington.edu Figure 2: Bronchial Hygiene Flowchart Figure 1: IDST Flowchart