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Development of a Clinical Decision Support Tool for Facilitating Naturalistic Decision-Making and Improving Blood Culture Utilization

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Sepsis is a life-threatening complication of blood stream infections that affects 8 percent of infants in pediatric intensive care units (PICUs) and is responsible for 25 percent of PICU mortality. Blood cultures represent a cornerstone of the diagnosis and treatment of sepsis; however, overuse of blood cultures may result in unnecessary laboratory tests, unnecessary antibiotic use, prolonged hospitalization and increased health care costs. Existing clinical decision support (CDS) tools for optimizing blood culture utilization rely on analytic approaches to determine the pretest probability of blood stream infections, and they fail to address the naturalistic and intuitive nature of clinical decision-making, resulting in low adoption by providers.

Our Goals

This project will develop an electronic health record-embedded CDS tool that draws upon the strengths of analytical and naturalistic decision-making. The team will apply a sociotechnical systems approach and a user-centered design method to guide the development of the CDS tool. The tool will be implemented in the PICU at The Johns Hopkins Hospital, and an interrupted time series study design will be used to evaluate its impact on blood culture utilization and patient outcomes.

Principal Investigators: Anping Xie
Research Team Members: James Fackler, Aaron Milstone, Scott Levin, Matthew Toerper
Funding Agency: Agency for Healthcare Research and Quality
Funding Support: $295,000
Dates: 4/1/2017 - 3/31/2019

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