Improved Time to Notification of Impending Brain Death and Increased Organ Donation Using an Electronic Clinical Decision Support System. Issue 8 (9th May 2017)

• Record Type: Journal Article
• Authors: Zier, J. L.; Spaulding, A. B.; Finch, M.; Verschaetse, T.; Tarrago, R.
• Is Part Of: American journal of transplantation. Volume 17:Issue 8(2017)
• Page Start: 2186
• Page End: 2191
• Publication Date: 2017-05-09
• Subjects: clinical research/practice -- pediatrics -- organ transplantation in general -- donors and donation: deceased -- informatics -- patient referral -- organ procurement organization; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.14312
• Languages: English
• ISSNs: 1600-6135

Abstract

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. Abstract : The authors describe the development of an electronic clinical decision support system that identifies and automatically notifies an organ procurement agency of children with impending brain death, and report the improved timeliness of donation referral and increased organ donation after implementation.