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Integrating Clinical Decision Support into the Evaluation of the Pediatric Trauma Patient
Leah M. Kechele, DNP, RN1, Benjamin L. Eithun MSN, CRNP, RN, CPNP-AC, CCRN1, Joshua C. Ross, MD, FAAP2, Mary Jean Ersche - Cooke, RN, MS, BSN, CPEN1, Jeanne Little, DNP, CRNP, RN, CPNP- AC, PC3. 1American Family Children's Hospital, University of Wisconsin Hospital and Clinics, Madison, WI, USA, 2Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA, 3College of Nursing, Rush University, Chicago, IL, USA.

The aim was to minimize the number of unnecessary computed tomography (CT) scans obtained during the evaluation of pediatric trauma patients in a level 1 trauma center. An order set was created and implemented into the electronic medical record (EMR), integrating clinical decision support at the time of order entry to guide the provider in choosing alternative diagnostic tools to the CT scan when clinically appropriate, specifically for minor head traumas and aid in spine clearance. Retrospective chart reviews were utilized following IRB approval to evaluate the use of the order set and adherence to clinical decision guidelines following the project implementation. This data collection occurred over 1 year, and is currently ongoing until August 2016. Data from August 2014-2015 was used as baseline data. Following the intervention, 78.7% (26/33) of the pediatric trauma patients who underwent appropriate spinal imaging had orders placed using the order set. 12.5% (17/135) had a CT of their spine without initial radiographs (not following guideline), which is comparable and slightly higher than the pre-intervention group of 9.3% (30/321), currently showing no change following the intervention. 55% (77/135) of the total post intervention group were evaluated using the pediatric order set. Although data collection is ongoing, it is the conclusion of this project that integrating clinical decision support tools into the EMR at the point of order entry can improve adherence to guidelines in the setting of pediatric trauma evaluation in a combined pediatric and adult emergency department.


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