title: Effect of clinical decision support on documented guideline adherence for head CT in emergency department patients with mild traumatic brain injury.
abstract: Imaging utilization in emergency departments (EDs) has increased significantly. More than half of the 1.2 million patients with mild traumatic brain injury (MTBI) presenting to US EDs receive head CT. While evidence-based guidelines can help emergency clinicians decide whether to obtain head CT in these patients, adoption of these guidelines has been highly variable. Promulgation of imaging efficiency guidelines by the National Quality Forum has intensified the need for performance reporting, but measuring adherence to these imaging guidelines currently requires labor-intensive and potentially inaccurate manual chart review. We implemented clinical decision support (CDS) based on published evidence to guide emergency clinicians towards appropriate head CT use in patients with MTBI and automated data capture needed for unambiguous guideline adherence metrics. Implementation of the CDS was associated with a 56% relative increase in documented adherence to evidence-based guidelines for imaging in ED patients with MTBI.
authors.affiliation: Center for Evidence-Based Imaging, Brigham and Women's Hospital, Brookline, Massachusetts, USA Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Anurag
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Center for Evidence-Based Imaging, Brigham and Women's Hospital, Brookline, Massachusetts, USA Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Ivan K
authors.initials: IK
authors.lastname: Ip
authors.affiliation: Center for Evidence-Based Imaging, Brigham and Women's Hospital, Brookline, Massachusetts, USA Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Ali S
authors.initials: AS
authors.lastname: Raja
authors.affiliation: Center for Evidence-Based Imaging, Brigham and Women's Hospital, Brookline, Massachusetts, USA Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Andruchow
authors.affiliation: Center for Evidence-Based Imaging, Brigham and Women's Hospital, Brookline, Massachusetts, USA Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Sodickson
authors.affiliation: Center for Evidence-Based Imaging, Brigham and Women's Hospital, Brookline, Massachusetts, USA Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Ramin
authors.initials: R
authors.lastname: Khorasani
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000000981:diagnostic imaging*; D020000:Decision Support Systems, Clinical; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D014057:Tomography, X-Ray Computed / Q000592:standards / Q000706:statistics & numerical data*; D014193:Trauma Centers
keywords: Computerized Physician Order Entry System; Decision Support Systems, Clinical; Electronic Health Records; Evidence-Based Practice; Radiology