title: Impact of a clinical decision support tool on adherence to the Ottawa Ankle Rules.
abstract: OBJECTIVE
  The objective of the study is to determine impact of a clinical decision support (CDS) tool on documented adherence to the Ottawa Ankle Rules (OAR) and utilization and yield of ankle/foot radiography, for emergency department patients with acute ankle injury.
  
  
  METHODS
  This is a before-and-after intervention study conducted at a 793-bed, quaternary care, academic hospital from August 2012 to October 2013. Emergency department visits from adults with acute ankle injury 6 months before and 8 months after the intervention were included. The intervention embedded the OAR into a CDS tool integrated with a computerized physician order entry system, which had data capture capability and provided feedback at the time of ankle/foot radiography order. Primary outcome was rate of documented adherence to OAR. Secondary outcomes were utilization and yield (clinically significant fracture rates among patients with acute ankle injuries) of ankle/foot radiography.
  
  
  RESULTS
  The study population included 460 visits; 205 (44.6%) occurred preintervention. After intervention, documented OAR adherence increased from 55.9% (229/410) to 95.7% (488/510; P < .001). Utilization remained stable for ankle (77.5%; P = .800) and foot (48.6%; P = .514) radiography. Yield remained stable for ankle (17.8%; P = .891) and foot (19.8%; P = .889) radiography.
  
  
  CONCLUSIONS
  Lack of documentation of key clinical data may hamper provider communication, delay care coordination, and result in legal liability. By embedding the OAR into a CDS tool, we achieved the same rate of documented adherence as previous onerous educational implementations while automating data collection/retrieval. In summary, implementation of the OAR into a CDS tool was associated with an increase in documented adherence to the OAR.
authors.affiliation: Center for Evidence Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: pcbsilveira@gmail.com.
authors.forename: Patricia C
authors.initials: PC
authors.lastname: Silveira
authors.affiliation: Center for Evidence Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: iip@partners.org.
authors.forename: Ivan K
authors.initials: IK
authors.lastname: Ip
authors.affiliation: Center for Evidence Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: siobhansumption@gmail.com.
authors.forename: Siobhan
authors.initials: S
authors.lastname: Sumption
authors.affiliation: Center for Evidence Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: asraja@partners.org.
authors.forename: Ali S
authors.initials: AS
authors.lastname: Raja
authors.affiliation: Center for Evidence Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: stajmir@partners.org.
authors.forename: Shahein
authors.initials: S
authors.lastname: Tajmir
authors.affiliation: Center for Evidence Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: rkhorasani@bwh.harvard.edu.
authors.forename: Ramin
authors.initials: R
authors.lastname: Khorasani
mesh_terms: D000328:Adult; D016512:Ankle Injuries / Q000000981:diagnostic imaging*; D020000:Decision Support Systems, Clinical; D004282:Documentation; D004636:Emergency Service, Hospital; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011859:Radiography