Implementation and evaluation of electronic clinical decision support for compliance with pneumonia and heart failure quality indicators.

PURPOSE The ability of an automated system used to identify pneumonia and heart failure (HF) patients in real time and prompt clinical interventions was evaluated. SUMMARY An automated system evaluated all adult patients with an emergency department (ED) visit or hospital admission for possible pneumonia in real time for 31 days. Two quality-indicator alerts were sent to appropriate clinicians for possible interventions. The system evaluated all hospitalized adult patients for HF for 30 days. A list of possible HF patients printed every 12 hours and was used for possible interventions. Pneumonia and HF identification accuracy was assessed by comparison with discharge diagnosis. Compliance with quality indicators was assessed using three pneumonia and three HF indicators. The effect was measured by comparing compliance data and the number of monthly quality indicators in the top decile seven months before and after implementation. There were 3053 ED visits and 986 inpatient admissions during the pneumonia study. The system sensitivity for pneumonia ED identification was 89% and the specificity was 86%. The sensitivity for pneumonia admissions was 92% and the specificity was 90%. There were 1037 inpatient admissions during the HF study. The sensitivity for HF identification was 94% and the specificity was 90%. Sixty-seven percent of the six indicators studied increased the percentage of months in the top decile after implementation. The average increase was 26%. CONCLUSION An automated system effectively identified pneumonia and HF patients in real time. The system prompted interventions, which helped increase compliance with national quality indicators.