Evidence map›Paper›PMID 36754066›Full record

Trial reportApplied clinical informatics2023

Evaluation of an Antimicrobial Stewardship Decision Support for Pediatric Infections.

Erin A McGonagle, Dean J Karavite, Robert W Grundmeier, Sarah K Schmidt, Larissa S May, Daniel M Cohen, Andrea T Cruz, Shin-Ping Tu, Lalit Bajaj, Peter S Dayan and 1 more

Open access · bronzeAbstract readRandomized Controlled Trial
In one paragraph

Trial report in Applied clinical informatics, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 2 pooled it
2.2field-weighted citation impact, top 11% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 2 syntheses or guidelines pooled it, 12 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Article
  5. Article
  6. Review
  7. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 6 institutions in 1 country.

Erin A McGonagleDepartment of Pediatrics and Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States.
Dean J KaraviteDepartment of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States.
Robert W GrundmeierDepartment of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States.
Sarah K SchmidtDepartment of Pediatrics and Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States.
Larissa S MayDepartment of Emergency Medicine, University of California at Davis School of Medicine, Davis, California, United States.
Daniel M CohenDepartment of Pediatrics, The Ohio State University School of Medicine, Columbus, Ohio, United States.
Andrea T CruzDepartment of Pediatrics, Baylor College of Medicine, Houston, Texas, United States.
Shin-Ping TuDepartment of Medicine, University of California at Davis School of Medicine, Davis, California, United States.
Lalit BajajDepartment of Pediatrics and Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States.
Peter S DayanDepartment of Emergency Medicine and Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York, United States.
Rakesh D MistryDepartment of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, United States.
University of Colorado Denver · USChildren's Hospital of Philadelphia · USUniversity of California, Davis · USBaylor College of Medicine · USColumbia University · USThe Ohio State University · US

Funding

Creation of a Generalizable ED-based Antimicrobial Stewardship Program Using Electronic Health Record Clinical Decision SupportR21AI139839 · NIAID · UNIVERSITY OF COLORADO DENVER · PI MISTRY, RAKESH D · 2018 to 2019
$415k
NIAID NIH HHS R21 AI139839
6 · The paper itself

Abstract

objectivesClinical decision support (CDS) has promise for the implementation of antimicrobial stewardship programs (ASPs) in the emergency department (ED). We sought to assess the usability of a newly developed automated CDS to improve guideline-adherent antibiotic prescribing for pediatric community-acquired pneumonia (CAP) and urinary tract infection (UTI).

methodsWe conducted comparative usability testing between an automated, prototype CDS-enhanced discharge order set and standard order set, for pediatric CAP and UTI antibiotic prescribing. After an extensive user-centered design process, the prototype CDS was integrated into the electronic health record, used passive activation, and embedded locally adapted prescribing guidelines. Participants were randomized to interact with three simulated ED scenarios of children with CAP or UTI, across both systems. Measures included task completion, decision-making and usability errors, clinical actions (order set use and correct antibiotic selection), as well as objective measures of system usability, utility, and workload using the National Aeronautics and Space Administration Task Load Index (NASA-TLX). The prototype CDS was iteratively refined to optimize usability and workflow.

resultsUsability testing in 21 ED clinical providers demonstrated that, compared to the standard order sets, providers preferred the prototype CDS, with improvements in domains such as explanations of suggested antibiotic choices (

conclusionOur CDS-enhanced discharge order set for ED antibiotic prescribing was strongly preferred by users, improved the accuracy of antibiotic prescribing, and trended toward reduced provider workload. The CDS was optimized for impact on guideline-adherent antibiotic prescribing from the ED and end-user acceptability to support future evaluative trials of ED ASPs.

Indexed as

Antimicrobial StewardshipCommunity-Acquired InfectionsDecision Support Systems, ClinicalAnti-Bacterial AgentsChildElectronic Health RecordsEmergency Service, HospitalHumansAnti-Bacterial Agents

Identifiers

PMID36754066
PMCPMC9908419
OpenAlexW4319455557

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.