Education and Education and Clinical Decision Support: Clinical Decision Support: Reuniting Twins Separated Reuniting Twins Separated at Birth at Birth Jerry Osheroff, M.D. Jerry Osheroff, M.D. Thomson Healthcare Thomson Healthcare University of University of Pennsylvania Pennsylvania
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Education and Clinical Decision Support: Reuniting Twins Separated at Birth
Education and Clinical Decision Support: Reuniting Twins Separated at Birth. Jerry Osheroff, M.D. Thomson Healthcare University of Pennsylvania. Objectives. Outline the need for a joint model for education and clinical decision support - PowerPoint PPT Presentation
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Education and Education and Clinical Decision Support:Clinical Decision Support:
Reuniting Twins Separated at BirthReuniting Twins Separated at Birth
Jerry Osheroff, M.D.Jerry Osheroff, M.D.
Thomson HealthcareThomson Healthcare
University of PennsylvaniaUniversity of Pennsylvania
ObjectivesObjectives
Outline the need for a joint model for Outline the need for a joint model for education and clinical decision education and clinical decision supportsupport
Describes how the two can be used Describes how the two can be used together to achieve outstanding care together to achieve outstanding care delivery and outcomes.delivery and outcomes.
Healthcare is BrokenHealthcare is BrokenSafetySafety 1 medication error/inpatient/day 1 medication error/inpatient/day – IOM– IOM >500K preventable ADE deaths/injuries (outpt) >500K preventable ADE deaths/injuries (outpt) – IOM– IOM
QualityQuality 55% chance of appropriate care 55% chance of appropriate care – McGlynn/NEJM– McGlynn/NEJM 17 years: effective treatment ->routine 17 years: effective treatment ->routine – Balas/IMIA– Balas/IMIA
Orthopedic Surgery VTE prophylaxis schema for Orthopedic Surgery VTE prophylaxis schema for hip and knee arthroplasty and hip fracture surgeryhip and knee arthroplasty and hip fracture surgery
Any CONTRAINDICATIONS to pharmacologic prophylaxis?
High risk of bleeding Active bleeding
Systemic anticoagulation INR ≥ 1.5 or aPTT ratio ≥ 1.3
Platelet count < 50,000
Yes
Use TEDs/SCDs until contraindication no longer present. Consider serial duplex surveillance
or vena caval filter in high-risk orthopedic patients (Hip or knee arthroplasty-particularly with VTE risk
factors, Hip fracture surgery, major trauma, spine surgery with risk factors)
No Creatinine clearance < 30 ml/min
No
Hip surgery with VTE risk factors? Previous DVT/PE
(Begin day of surgery)(Use 2.5 mg for age>75, CHF or liver disease, interacting meds)
May addSCDs Foot pumps
Hip surgery with VTE risk factors? Previous DVT/PE
CancerThrombophiliaMajor trauma
Complete 14 days of prophylaxis
Consider extended prophylaxis for 28 days post-op with
Warfarin (INR 2-3)(with at least weekly INR)
Yes
No
Not in order set
Goal of EducationGoal of Education
Existing knowledge Exis
ting k
now
ledge
New knowledge
Provide cognitive framework, skills, and beliefs necessary for practice.
Tools of EducationTools of Education
DIDACTIC EXPERIENTIAL
Information Case PracticeBased Based Based
-Informational -Fictional -Apprenticeship
text & graphics or real -Quality -Books cases Improvement -Lectures -Virtual -Point of care
patients
Goals of CDSGoals of CDS
““Providing clinicians or patients with Providing clinicians or patients with clinical knowledgeclinical knowledge and patient-related and patient-related information, intelligently filtered or presented information, intelligently filtered or presented at appropriate times, at appropriate times, to enhance patient to enhance patient carecare.” .”
Includes and builds on what’s already being done Includes and builds on what’s already being done on a daily basis in healthcare organizations…on a daily basis in healthcare organizations…
NOTNOT just rules and alerts… just rules and alerts…
Point of care learningPoint of care learning• Leverages decision support tools and adds reflective componentLeverages decision support tools and adds reflective component• Responds to learning needs from patients’ clinical problems ***Responds to learning needs from patients’ clinical problems ***
Quality improvementQuality improvement• Broader examination of quality gapsBroader examination of quality gaps• Integrated into Maintenance of CertificationIntegrated into Maintenance of Certification
** Regnier et al., JCEHP 2005** Regnier et al., JCEHP 2005
*** Davis and Willis, JCEHP 2004*** Davis and Willis, JCEHP 2004
5 ‘Rights’: Joint Model for Education and CDS5 ‘Rights’: Joint Model for Education and CDS
CDS and Education should provide:CDS and Education should provide:
• the right the right informationinformation (ebm),(ebm),
• to the right to the right personperson (clinicians (clinicians andand patients…), patients…),
• in the right intervention in the right intervention format or activityformat or activity (alert, (alert, answer, virtual patient, assessment, reflection),answer, virtual patient, assessment, reflection),
• at the right point in at the right point in timetime (relative to workflow and other (relative to workflow and other interventions)interventions)
• through the right through the right systemssystems and and peoplepeople (cds and (cds and education professionals, multimodal solutions)education professionals, multimodal solutions)
to improve health care delivery and outcomesto improve health care delivery and outcomes. .
Keys to Joint ModelKeys to Joint Model
Comprehensive user needs assessmentComprehensive user needs assessment
Diverse development team (clinical Diverse development team (clinical experts, informaticians, educators)experts, informaticians, educators)
Multiple interventions and modalitiesMultiple interventions and modalities