Implementation of an Electronic Clinical Decision Support Tool for Pediatric Appendicitis Within a Hospital Network.

Abstract

Computed tomography (CT) has been widely used in the evaluation of children with suspected appendicitis, but concerns about ionizing radiation have increased interest in ultrasound for these patients. We sought to assess the effectiveness of an appendicitis electronic clinical decision support (E-CDS) system in increasing ultrasound and decreasing CT use in children evaluated in emergency departments (EDs) for suspected appendicitis. This was a preintervention and postintervention analysis of an E-CDS implemented into an electronic health record system shared by an academic, tertiary-care children's hospital and a community hospital. The tool consisted of a structured order set with embedded clinical advice and a link to a Web site. Emergency department patients aged 3 to 18 years with suspected appendicitis were reviewed retrospectively. Imaging use was assessed 3 months before and 6 months after implementation of the intervention. Three hundred twenty-seven patients were identified, 211 at postintervention; 80% were seen in the community ED. Among community ED patients with imaging, ultrasound use increased (36%-51%, P = 0.049), and CT scan use decreased (81%-66%, P = 0.044) in the postintervention period, with no change in complications or safety outcomes. No difference was found in ultrasound rate (100%-97%, P = 1.000) or CT scan rate (13%-10%, P = 1.000) among children's ED patients with imaging. An E-CDS can effectively decrease CT scanning and increase use of ultrasound in children with suspected appendicitis in a community hospital ED. Electronic clinical decision support may be an effective method of disseminating pediatric best practices from a children's hospital to affiliated community EDs.