Clinical Decision Support for Hyperbilirubinemia Risk Assessment in the Electronic Health Record.

Physiologic neonatal hyperbilirubinemia (jaundice) is common and affects most newborn infants. However, there is a risk for permanent neurological damage if the bilirubin levels rise above a certain threshold. The management of neonatal jaundice includes the assessment of bilirubin laboratory values...

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Publicado en:Academic Pediatrics Vol. 20; no. 6; pp. 857 - 863
Autores principales: Petersen, John D., Lozovatsky, Margaret, Markovic, Daniela, Duncan, Ray, Zheng, Simon, Shamsian, Arash, Kagele, Sonya, Ross, Mindy K.
Formato: research tables/charts Journal Article
Publicado: Elsevier B.V. Aug2020
Acceso en línea:Ver este registro en EBSCOhost
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      pub: Elsevier B.V.
      place: New York, New York
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        10.1016/j.acap.2020.02.009
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        atl: Clinical Decision Support for Hyperbilirubinemia Risk Assessment in the Electronic Health Record.
      aug:
        au:
          Petersen, John D.
          Lozovatsky, Margaret
          Markovic, Daniela
          Duncan, Ray
          Zheng, Simon
          Shamsian, Arash
          Kagele, Sonya
          Ross, Mindy K.
        affil: Olive View-UCLA Medical Center (JD Petersen), Sylmar, Calif
      sug:
        subj:
          Decision Support Techniques
          Hyperbilirubinemia
          Risk Assessment
          Electronic Health Records
          Human
          Decision Making, Clinical
          Jaundice, Neonatal
      ab: Physiologic neonatal hyperbilirubinemia (jaundice) is common and affects most newborn infants. However, there is a risk for permanent neurological damage if the bilirubin levels rise above a certain threshold. The management of neonatal jaundice includes the assessment of bilirubin laboratory values, consideration of patient-specific risk factors, and plotting on a bilirubin nomogram reference to determine risk and guide therapy. When performed manually, the process can be time consuming and error-prone. Therefore, web-based calculators such as BiliTool have been developed to assist in risk assessment. To streamline the risk assessment calculation process further within our electronic health record (EHR), we created a "BiliReport" to display patient bilirubin-related data and automate transmission of deidentified patient data to the BiliTool website (https://bilitool.org). After implementation, we evaluated usage data, provider satisfaction, and accuracy of documentation. We demonstrated high provider use of the BiliReport and satisfaction with the workflow. We found a significant improvement in the accuracy of bilirubin risk level documentation, with a reduction in erroneous risk stratification from 4% (15/232) to 0.4% (1/243), P < 0.001. We did not find significant a difference in erroneous documentation of the bilirubin lab value (P = 0.07). Integrating the neonatal hyperbilirubinemia risk assessment process into the EHR may reduce errors and improve provider documentation and adherence to recommended guidelines.
      pubtype: Academic Journal
      doctype:
        research
        tables/charts
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    language: English
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