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Using the electronic medical record to improve education in patients at risk for adrenal insufficiency.

Schweiger B, Zeitler P, Eppley S, Swietlik M, Barker J - Int J Pediatr Endocrinol (2010)

Bottom Line: Conclusion.This report documents that an automated alert in the EMR can promote improved provider adherence to recommendations regarding ongoing education of patients for stress dosing of glucocorticoids.Whether this translates into better outcomes for patients remains to be seen.

View Article: PubMed Central - PubMed

Affiliation: The Children's Hospital, University of Colorado Denver, East 16th Avenue, B265 Aurora, CO 13123, USA.

ABSTRACT
Background. Adrenal insufficiency is a life-threatening event. It is recommended that patients with known adrenal insufficiency and their families receive careful and repeated education on sick-day glucocorticoid management. We hypothesized that the electronic medical record (EMR) can be used to improve patient education through automated provider notification. Methods. We established an automated electronic alert in the EMR that triggered in the outpatient endocrine clinic. The alert asked if stress dose education was reviewed at the visit. The response to this alert was evaluated between July 15, 2009 and February 19, 2010. Results. 128 unique patients had visits both prior to and following the implementation of the EMR alert. The alert was acknowledged in 58 unique patient visits. After the alert was implemented, 87/128 (68%) of the patients had documentation in their record that stress dosing was reviewed. In the visit just prior to implementation of the alert, 48/128 (38%) of the patient encounters showed written documentation of stress dose review. Conclusion. This report documents that an automated alert in the EMR can promote improved provider adherence to recommendations regarding ongoing education of patients for stress dosing of glucocorticoids. Whether this translates into better outcomes for patients remains to be seen.

No MeSH data available.


Related in: MedlinePlus

Flow chart of pediatric endocrinology stress dosing alert summary.
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Related In: Results  -  Collection


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fig2: Flow chart of pediatric endocrinology stress dosing alert summary.

Mentions: During this period, we identified 182 unique patient visits that activated the alert (Figure 2). Of these, 25 were erroneous activations for treatment with short courses of prednisone (2 weeks or less) for other medical conditions such as asthma or inflammatory bowel disease and so were excluded. Another 29 of the patients were excluded because they were initially seen in our clinic only after the alert was implemented. Of the 128 remaining patients who had visits both before and after implementation, the alert was acknowledged in 58 (45%). From the 58 acknowledgments, there were 56 encounters in which the provider indicated that stress dosing was discussed with the patients and written documentation was provided in 48 (86%) of these. The alert was not acknowledged in 70 encounters, in which 39 (56%) showed written documentation of stress dose hydrocortisone education. Thus, after the alert was implemented, 87/128 (68%) of the patients had documentation in their record that stress dosing was reviewed. In the visit just prior to initiation of the alert, written documentation of teaching was provided in 48/128 (38%) of the corresponding patients. In addition, we found that the alert was acknowledged in 14/31 (45%) encounters in the first month (July 15-August 15, 2009) that it was implemented compared with the fifth month of implementation when it was acknowledged in 15/ 29 encounters (January 19-February 19, 2010).


Using the electronic medical record to improve education in patients at risk for adrenal insufficiency.

Schweiger B, Zeitler P, Eppley S, Swietlik M, Barker J - Int J Pediatr Endocrinol (2010)

Flow chart of pediatric endocrinology stress dosing alert summary.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2913793&req=5

fig2: Flow chart of pediatric endocrinology stress dosing alert summary.
Mentions: During this period, we identified 182 unique patient visits that activated the alert (Figure 2). Of these, 25 were erroneous activations for treatment with short courses of prednisone (2 weeks or less) for other medical conditions such as asthma or inflammatory bowel disease and so were excluded. Another 29 of the patients were excluded because they were initially seen in our clinic only after the alert was implemented. Of the 128 remaining patients who had visits both before and after implementation, the alert was acknowledged in 58 (45%). From the 58 acknowledgments, there were 56 encounters in which the provider indicated that stress dosing was discussed with the patients and written documentation was provided in 48 (86%) of these. The alert was not acknowledged in 70 encounters, in which 39 (56%) showed written documentation of stress dose hydrocortisone education. Thus, after the alert was implemented, 87/128 (68%) of the patients had documentation in their record that stress dosing was reviewed. In the visit just prior to initiation of the alert, written documentation of teaching was provided in 48/128 (38%) of the corresponding patients. In addition, we found that the alert was acknowledged in 14/31 (45%) encounters in the first month (July 15-August 15, 2009) that it was implemented compared with the fifth month of implementation when it was acknowledged in 15/ 29 encounters (January 19-February 19, 2010).

Bottom Line: Conclusion.This report documents that an automated alert in the EMR can promote improved provider adherence to recommendations regarding ongoing education of patients for stress dosing of glucocorticoids.Whether this translates into better outcomes for patients remains to be seen.

View Article: PubMed Central - PubMed

Affiliation: The Children's Hospital, University of Colorado Denver, East 16th Avenue, B265 Aurora, CO 13123, USA.

ABSTRACT
Background. Adrenal insufficiency is a life-threatening event. It is recommended that patients with known adrenal insufficiency and their families receive careful and repeated education on sick-day glucocorticoid management. We hypothesized that the electronic medical record (EMR) can be used to improve patient education through automated provider notification. Methods. We established an automated electronic alert in the EMR that triggered in the outpatient endocrine clinic. The alert asked if stress dose education was reviewed at the visit. The response to this alert was evaluated between July 15, 2009 and February 19, 2010. Results. 128 unique patients had visits both prior to and following the implementation of the EMR alert. The alert was acknowledged in 58 unique patient visits. After the alert was implemented, 87/128 (68%) of the patients had documentation in their record that stress dosing was reviewed. In the visit just prior to implementation of the alert, 48/128 (38%) of the patient encounters showed written documentation of stress dose review. Conclusion. This report documents that an automated alert in the EMR can promote improved provider adherence to recommendations regarding ongoing education of patients for stress dosing of glucocorticoids. Whether this translates into better outcomes for patients remains to be seen.

No MeSH data available.


Related in: MedlinePlus