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Assadi A, Laussen PC, Freire G, Ghassemi M, Trbovich PC. Effect of clinical decision support systems on emergency medicine physicians' decision-making: A pilot scenario-based simulation study. Front Pediatr 2022; 10:1047202. [PMID: 36589162 PMCID: PMC9798305 DOI: 10.3389/fped.2022.1047202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/17/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Children with congenital heart disease (CHD) are predisposed to rapid deterioration in the face of common childhood illnesses. When they present to their local emergency departments (ED) with acute illness, rapid and accurate diagnosis and treatment is crucial to recovery and survival. Previous studies have shown that ED physicians are uncomfortable caring for patients with CHD and there is a lack of actionable guidance to aid in their decision making. To support ED physicians' key decision components (sensemaking, anticipation, and managing complexity) when managing CHD patients, a Clinical Decision Support System (CDSS) was previously designed. This pilot study evaluates the effect of this CDSS on ED physicians' decision making compared to usual care without clinical decision support. METHODS In a pilot scenario-based simulation study with repeated measures, ED physicians managed mock CHD patients with and without the CDSS. We compared ED physicians' CHD-specific and general decision-making processes (e.g., recognizing sepsis, starting antibiotics, and managing symptoms) with and without the use of CDSS. The frequency of participants' utterances related to each key decision components of sensemaking, anticipation, and managing complexity were coded and statistically analyzed for significance. RESULTS Across all decision-making components, the CDSS significantly increased ED physicians' frequency of "CHD specific utterances" (Mean = 5.43, 95%CI: 3.7-7.2) compared to the without CDSS condition (Mean = 2.05, 95%CI: 0.3-3.8) whereas there was no significant difference in frequencies of "general utterances" when using CDSS (Mean = 4.62, 95%CI: 3.1-6.1) compared to without CDSS (Mean = 5.14 95%CI: 4.4-5.9). CONCLUSION A CDSS that integrates key decision-making components (sensemaking, anticipation, and managing complexity) can trigger and enrich communication between clinicians and enhance the clinical management of CHD patients. For patients with complex and subspecialized diseases such as CHD, a well-designed CDSS can become part of a multifaceted solution that includes knowledge translation, broader communication around interpretation of information, and access to additional expertise to support CHD specific decision-making.
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Affiliation(s)
- Azadeh Assadi
- Labatt Family Heart Centre, Department of Critical Care Medicine, Hospital for Sick Children, Toronto, ON, Canada.,HumanEra, Institute of Biomaterials and Biomedical Engineering, Department of Engineering and Applied Sciences, University of Toronto, Toronto, ON, Canada
| | - Peter C Laussen
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.,Executive Vice President for Health Affairs, Boston Children's Hospital, Boston, MA, United States.,Professor of Anaesthesia, Harvard Medical School, Boston, MA, United States
| | - Gabrielle Freire
- Division of Emergency Medicine, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Marzyeh Ghassemi
- Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Boston, MA, United States.,Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Boston, MA, United States.,Vector Institute, Toronto, ON, Canada.,CIFAR AI Chair, Vector Institute, Toronto, ON, Canada
| | - Patricia C Trbovich
- HumanEra, Institute of Biomaterials and Biomedical Engineering, Department of Engineering and Applied Sciences, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Research and Innovation, North York General Hospital, Toronto, ON, Canada
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Choi RS, DiNardo JA, Brown ML. Superior Cavopulmonary Connection: Its Physiology, Limitations, and Anesthetic Implications. Semin Cardiothorac Vasc Anesth 2020; 24:337-348. [PMID: 32646291 DOI: 10.1177/1089253220939361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The superior cavopulmonary connection (SCPC) or "bidirectional Glenn" is an integral, intermediate stage in palliation of single ventricle patients to the Fontan procedure. The procedure, normally performed at 3 to 6 months of life, increases effective pulmonary blood flow and reduces the ventricular volume load in patients with single ventricle (parallel circulation) physiology. While the SCPC, with or without additional sources of pulmonary blood flow, cannot be considered a long-term palliation strategy, there are a subset of patients who require SCPC palliation for a longer interval than the typical patient. In this article, we will review the physiology of SCPC, the consequences of prolonged SCPC palliation, and modes of failure. We will also discuss strategies to augment pulmonary blood flow in the presence of an SCPC. The anesthetic considerations in SCPC patients will also be discussed, as these patients may present for noncardiac surgery from infancy to adulthood.
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Affiliation(s)
- Ray S Choi
- Children's Hospital Colorado, Denver, CO, USA.,Boston Children's Hospital, Boston, MA, USA
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