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Improved Time to Notification of Impending Brain Death and Increased Organ Donation Using an Electronic Clinical Decision Support System
Author(s) -
Zier J. L.,
Spaulding A. B.,
Finch M.,
Verschaetse T.,
Tarrago R.
Publication year - 2017
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.14312
Subject(s) - medicine , organ donation , referral , clinical decision support system , donation , medical record , medical emergency , affect (linguistics) , electronic medical record , emergency medicine , pediatrics , family medicine , decision support system , transplantation , artificial intelligence , computer science , economics , economic growth , linguistics , philosophy
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.