Abstract
BackgroundPatient care order sets are increasingly being used to optimize care. While studies have evaluated the impact of order sets on provider performance and patient outcomes, their impact on postgraduate medical trainee knowledge remains unknown. We sought to evaluate the impact of order sets on respirology knowledge, order-writing skills, and self-reported learning.MethodsWe conducted a prospective before-after study. Postgraduate trainees completing a Respirology rotation at a quaternary-care hospital 6 months before (no order set period) and 12 months after (order set period) order set introduction. Guideline-based admission order sets with educational prompts detailing recommended management of cystic fibrosis and chronic obstructive pulmonary disease were implemented on the respirology ward. Each resident completed a test before and after the rotation assessing knowledge and order-writing. Residents in the order set period additionally completed a questionnaire regarding the impact of order set use on their learning. Analysis: The primary outcome, the difference between pre and post rotation scores was compared between residents in the no order set period and residents in the order set period, using univariate linear regression. Test validity was assessed with a 2-sample t-test, analysis of variance and Pearson’s correlation coefficient. Self-reported impact of order set use were descriptively analyzed, and written responses were collated and coded.ResultsInvestigators consecutively recruited 11 subjects before and 28 subjects after order set implementation. Residents in the order set period had a greater improvement in post-rotation test scores than residents in the no order set period (p = 0.04); after adjustment for baseline scores, this was not significant (p = 0.3). The questionnaire demonstrated excellent convergent, discriminant and construct validity. Residents reported that order sets improved their knowledge and skills and provided a systematic approach to care.ConclusionsOrder sets do not appear to impair resident education, and may impart a benefit. This will require validation in larger studies and across diseases.
Highlights
Patient care order sets are increasingly being used to optimize care
While studies have evaluated the impact of order sets on provider performance and patient outcomes [4,5], their impact on postgraduate medical trainee knowledge remains unknown
Pneumonia admission order-writing skills among medical students trained at hospitals using computerized provider order-entry (CPOE) compared to those using handwritten orders were no different [9]
Summary
Study design This was a prospective before-and-after exploratory study conducted on the Respirology ward of a quaternary care University of Toronto-affiliated hospital. Where a strong level of evidence existed to direct practice, specific physician prompts were integrated into the order sets, with an indication of the level of evidence supporting the recommendation (as graded by clinical practice guidelines [10]) as well as the expected outcome Their primary purpose was to enable care, as such, the order sets could serve as an educational tool with the provision of diagnostic and management choices, evidence-based recommendations and reference resources. For residents in the order set period, we included open-ended questions as part of their post-rotation test; these questions ascertained involvement in patient care and order set use, and probed the perceived impact of order set use on knowledge and skills (Part A Questions 4 and 5, Additional file 1: post-rotation questionnaire). For qualitative analyses regarding the impact of order set use on resident knowledge, we collated and coded written responses to the open ended questions from post-rotation tests of residents in the order set period. Ethical approval The study was approved by the hospital’s review board; informed consent was obtained from participants
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