title: Improved Time to Notification of Impending Brain Death and Increased Organ Donation Using an Electronic Clinical Decision Support System.
abstract: Early referral of patients to an organ procurement organization (OPO) may positively affect donation outcomes. We implemented an electronic clinic decision support (CDS) system to automatically notify our OPO of children meeting clinical triggers indicating impending brain death. Medical records of all patients who died in a pediatric critical care unit or were referred for imminent death for 3 years prior to installation of the initial CDS (pre-CDS) and for 1 year after implementation of the final CDS (post-CDS) were reviewed. Mean time to OPO notification decreased from 30.2 h pre-CDS to 1.7 h post-CDS (p = 0.015). Notification within 1 h of meeting criteria increased from 36% pre-CDS to 70% post-CDS (p = 0.003). Although an increase in donor conversion from 50% pre-CDS to 90% post-CDS did not reach statistical significance (p = 0.0743), there were more organ donors post-CDS (11 of 24 deaths) than pre-CDS (seven of 57 deaths; p = 0.002). Positive outcomes were achieved with the use of a fully automated CDS system while simultaneously realizing few false-positive notifications, low costs, and minimal workflow interruption. Use of an electronic CDS system in a pediatric hospital setting improved timely OPO notification and was associated with increased organ donation.
authors.affiliation: Pediatric Critical Care, Children's Minnesota, Minneapolis, MN.
authors.forename: J L
authors.identifier: http://orcid.org/0000-0001-6389-3422
authors.initials: JL
authors.lastname: Zier
authors.affiliation: Center for Acute Care Outcomes, Children's Minnesota, Minneapolis, MN.
authors.forename: A B
authors.initials: AB
authors.lastname: Spaulding
authors.affiliation: Research and Sponsored Programs, Children's Minnesota, Minneapolis, MN.
authors.forename: M
authors.initials: M
authors.lastname: Finch
authors.affiliation: LifeSource, Minneapolis, MN.
authors.forename: T
authors.initials: T
authors.lastname: Verschaetse
authors.affiliation: Pediatric Critical Care, Seattle Children's Hospital, Seattle, WA.
authors.forename: R
authors.initials: R
authors.lastname: Tarrago
mesh_terms: D000293:Adolescent; D000328:Adult; D001926:Brain Death; D002648:Child; D002675:Child, Preschool; D020000:Decision Support Systems, Clinical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016377:Organ Transplantation; D011379:Prognosis; D012017:Referral and Consultation; D012189:Retrospective Studies; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement / Q000379:methods*; D055815:Young Adult
keywords: clinical research/practice; donors and donation: deceased; informatics; organ procurement organization; organ transplantation in general; patient referral; pediatrics