Pros and Cons of Clinical Decision Support in Healthcare
A clinical decision support (CDS) system aims to lighten the burden on nurses, physicians, and the healthcare team. These algorithms use patient data to improve safety, but they’re not without drawbacks.
What should you know as a nursing professional using CDS programs? Let’s dig into what clinical decision systems are, real-world examples, and potential pros and cons.
While they sound ultra-modern, the concept of CDS systems has been around since the 1950s, when researchers first proposed using computers for medical decision-making. As electronic health records (EHRs) became the norm in the 1990s and 2000s, CDS tools were increasingly integrated into care, using evidence-based guidelines and data to help clinicians make good choices.
The most current CDS programs integrate artificial intelligence and have access to more data than ever before. Professionals like nurse informaticists and information technology experts are tasked with developing, maintaining, and continuing to improve CDS systems.
What Is Clinical Decision Support?
CDS systems are digital programs that provide information and recommendations to clinicians at the point of care. They can flag potential safety issues, suggest interventions, and execute routine tasks. To complete these goals, CDS tools use information about patients, evidence-based practices, preset algorithms, and AI.
CDS programs decrease sentinel events, can improve patient education, boost efficiency, and promote the latest clinical guidelines. Here are a few of the ways CDS is used in the clinical setting:
- Diagnostic: Using results from blood labs, urine tests, patient history, and more to rule out or detect potential diagnoses.
- Medication: Flagging potential medication interactions, showing at-a-glance MAR information, and suggesting meds and dosage.
- Risk flagging: Finding potential complications based on documented patient information, testing, medication reconciliation, or diagnoses.
- Guidance: Making recommendations for care based on patient data and evidence-based guidelines.
What is an example of clinical decision support in nursing care? Here are some real-world instances of CDS technology at work:
- Vital sign trends: In intensive care units where patients are continuously monitored, CDS can track trends in arterial pressure, heart rate, and respirations. These horizon trends reveal patterns in patients’ results, so that clinicians have additional context for current readings.
- Fall risk alerts: In a med-surg unit, a patient’s record is flagged as a fall risk after the nurse documents increasing confusion and decreased muscle strength. When the nurse clicks on this alert, the CDS recommends a fall alert wristband, bed alarm, and frequent rounds.
- Allergy: In an emergency department (ED), a patient has just been prescribed Amoxicillin when their medication record flashes red — they have a previously documented allergy to this medication.
What Are the 5 Rights of Clinical Decision Support?
In healthcare, patient safety and care quality are key. CDS tools improve care by using five rights:
- Right information: The data or information communicated needs to be correct and evidence-based.
- Right person: Information communicated by the CDS needs to be directed toward the correct person.
- Right format: Information must be accessible to the person it is being presented to, often through alerts, info buttons, or order sets.
- Right channel: CDS must communicate information through the appropriate channels, which may include mobile devices, the EHR, paper flowsheets, and more.
- Right time in the workflow: Information must be timely and arrive when the clinician needs it.
Clinical Decision Support System Tools: Pros and Cons for Nurses
| Pros | Cons |
|---|---|
| Can reduce medical errors, improve care quality, and help nurses manage care more effectively
Can help nurses document accurately and offer opportunities for continuous learning. Can lessen the documentation burden on nurses, giving them more time at the bedside. Nurses can make better clinical decisions using accessible patient data from CDS systems. |
Initial training and education can make more work for staff, pulling nursing professionals away from the bedside.
Systems require constant maintenance and updates to remain useful, and some are not accessible via smartphone. Current CDS systems fail to incorporate every part of the nursing process, so their applications may be somewhat limited. Malfunctions or errors in CDS systems can result in issues with workflow timing, communication, interruptions in documentation, and more. |
CDS FAQ
What is an example of a clinical decision?
Clinical decisions are choices made by nursing professionals, physicians, and other healthcare staff based on their expertise and patient data. For example:
- After shift report, a nurse prioritizes care by seeing her sickest patient first.
- Noticing high blood pressure in his patient, a nurse holds a blood pressure medication and alerts the provider about this change.
- A nurse calls the rapid response team after finding her patient unresponsive.
How does a CDS system work?
The most basic CDS programs run on rules, which are set by a system administrator. Rules are based on evidence, practice, or patient direction. For example, a rule may be that if a patient has an allergy to penicillin, then they should not receive it. The system gets data from the patient record to evaluate whether this rule has been violated, and sends an alert if it is.
More complex CDS programs rely on artificial intelligence, statistical pattern recognition, or machine learning, rather than programming. With AI CDS programs, for example, it’s not always possible to determine the exact reasoning behind the clinical decisions the system makes. As systems grow more complex, new challenges arise.
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