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The use of standardized order sets is not a new concept. Order sets have been in use in hospitals since the 1980’s (6), and they have evolved both in format and in the source of their content since their inception.
Studies with educational interventions other than the use of order sets and/or new guidelines are excluded Studies with other interventions (e.g. patient education, implementation of other new forms or charts, change in workflow not related to using the order sets) are excluded Studies that improved on their existing order sets (i.e. the control is an old order set) are excluded Retrospective studies where both the study and control group were selected in the period after the implementation of an order set, with the control group defined post-data collection as cases where the order set was not used by physicians. Studies published in a language other than English
Order sets are conveniently grouped medical orders that work to standardize diagnosis and treatment following pre-established clinical guidelines . Order sets are believed to make ordering more efficient (1) and represent a significant opportunity to decrease variation in care and enhance compliance with treatment guidelines. By grouping orders that should be placed together for diagnosis and treatment, order sets address the needs of both patients and clinicians by making the “right thing” easier to do (2). The groups in standardized order sets are based on standard practice guidelines and are normally extensively reviewed prior to implementation in clinical settings. The use of paper order sets has been reported to improve legibility, ensure the completeness and unambiguousness of orders, increase efficiency by reducing the need to verify and/or clarify orders, and standardize patient care (3). In addition, the expected benefits of standardized order set embedded in Computerized Physician Order Entry (CPOE) systems include increased user time-efficiency, improved completeness and accuracy of orders (4), reduced ordering of unnecessary tests (5), and improved patient outcomes.
Given the fact that there is very low quality evidence that order sets improve the rate of guideline adherence, processes of care, treatment outcomes, efficiency and cost, it is recommended that order sets for diagnosis and/or treatment become an important focus for further development through a formal evaluation of existing models.
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We analysed the impact of a standardized order set empowering staff nurses to independently manage a Fracture Liaison Service over a 9-month period. Nurses identified between 30 and 70 % of non-hip fragility fractures to the unit in charge of management over time. The latter managed 58 % of referred patients.
The loss of bone mass identified as osteoporosis or osteopenia can lead to osteoporosis-related fractures, namely fragility fractures [ 1 ]. Each year in Canada, 30,000 individuals sustain a hip fracture, which is associated with high morbidity and high mortality [ 2 – 5 ].
Effective on February 2014, an order set instituted in a hospital in Montreal, Quebec, Canada, legally allowed nurses with appropriate training to (1) identify fragility fractures, (2) refer patients to a special unit in charge of management, (3) screen for bone fragility with serum testing and bone densitometry, (4) prescribe a drug regimen for the prevention of subsequent fractures and (5) communicate with primary care physicians (PCPs) to transmit results.
A total of 346 patients ≥50 years old (71.1 % females aged 74.6 ± 13.6 years) were diagnosed with a fracture between November 2014 and July 2015, according to the medico-administrative database of the hospital. Of these 346 patients, 296 (74.3 % female) fulfilled the criteria for a fragility fracture after revision of medical files.
An order set was issued on February 2014, legally empowering nurses to manage by themselves fragility fracture patients in a hospital. The present study assessed the impact of the program on the identification and management of patients. Our results show that when the order set was applied, a rate of identification of 70 % could be reached (Fig.
In conclusion, the issuance of a standardized order set for the management of osteoporosis-related fractures was found to increase their identification and management over a 9-month period, largely exceeding that of standard of care.
We would like to thank Mrs. Liza O’Doherty, former Director of Nursing of the CSSS du Coeur-de-L’Île, for making possible the implementation of this program.
J.V.T. is supported by a Tier 1 Canada Research Chair in Health Services Research and a Career Investigator award from the Heart and Stroke Foundation of Ontario. The EFFECT study was supported by a Canadian Institutes of Health Research (CIHR) team grant in cardiovascular outcomes research to the Canadian Cardiovascular Outcomes Research Team (CCORT, www.ccort.ca ), and by an operating grant from the Canadian Institutes of Health Research on Measuring and Improving the Quality of ST-segment elevation AMI care. L.A. is supported by a CCORT post-doctoral award. ICES is supported by an operating grant from the Ontario Ministry of Health and Long-Term Care. P.C.A. is supported by a Career Investigator Award from the Heart and Stroke Foundation of Ontario. The results and conclusions are those of the authors, and should not be attributed to any of the sponsoring agencies.
In AMI, the use of standard admission orders was associated with improved hospital performance on several but not all acute process-of-care quality indicators. The utilization of standard admission orders should be considered as a strategy for improving hospital care in patients admitted with AMI.
Background: Mother and Child Health handbooks (MCH handbooks) serve as useful health education tools for mothers and sources of information that allow health care professionals to understand patient status. Therefore, it is necessary to clarify the effectiveness of and identify the factors related to possession of an MCH handbook among parents in rural Western Kenya using propensity score matching (PSM). Methods: A community-based cross-sectional survey using a structured questionnaire was conducted in rural western Kenya from August to September, 2011. We targeted 2560 mothers with children aged 12-24 months. Both PSM and multivariate logistic analyses were used in this study. Results: Impacts of 5.9, 9.4, and 12.6 percentage points for higher health knowledge and for proper health-seeking behavior for fever and diarrhea, respectively, were statistically significant. The significant factors affecting possession of the MCH Handbook were the child's sex, the caregiver's relationship to the child, maternal age, health knowledge, birth interval, household wealth index and CHW performance accordingly. Conclusions: An MCH handbook was an effective tool for improving both health knowledge and health-seeking behavior in Kenya. The further distribution and utilization of an MCH handbook is expected to be an effective way to improve both maternal and child health.
Care maps (CMs), which are innovative, comprehensive, educational, and simple medical tools, were developed for 6 common diseases, including heart failure, stroke, hyperglycemia, urinary tract infection, dengue infection, and upper gastrointestinal bleeding, were implemented in a short-stay ambulatory ward. This study aimed to investigate the effectiveness of and level of clinician satisfaction with CMs in an ambulatory care setting.A retrospective chart review study comparing the quality of care between before and after CM implementation was conducted. The medical records of patients who were admitted to a short-stay ambulatory ward in a tertiary referral center were reviewed. Demographic data, severity of disease, quality of care, length of stay (LOS), admission cost, and CM user satisfaction were collected and recorded.The medical records of 1116 patients were evaluated. Of those, 589 and 527 patients were from before (non-CM group) and after CM (CM group) implementation, respectively. There were no significant differences between groups for age, gender, or disease-specific severity the median (interquartile range) total and essential quality scores were significantly higher in the CM group than in the non-CM group [total quality score 85.3 (75.0-92.9) vs 61.1 (50.0-75.0); P < .001, and essential quality scores 90.0 (75.0-100.0) vs 60.0 (40.6-80.0); P < .0001, respectively]. All aspects of quality of care were significantly improved between before and after CM implementation. Overall median LOS was significantly decreased from 3.8 (2.5-5.7) to 3.0 (2.0-4.9) days, but there was no significant decrease for admission cost. However, CMs were able to significantly reduce both LOS and admission cost in the infectious disease-related subgroup. Most CM users reported satisfaction with CMs.CMs were shown to be an effective tool for improving the quality of care in patients with ambulatory infectious diseases. In that patient subgroup, LOS and admission cost were both significantly reduced compared to pre-CM implementation.