Clinical Decision Support Systems: Opportunities in Pediatric Patient Safety

Clinical decision support systems (CDSS) are tools, ideally embedded within electronic health systems, that can facilitate clinicians utilizing best practices and individual patient data to improve outcomes. While various iterations of CDSS have existed for years (including on paper-based charting systems), the past decade has seen an explosion of these systems. This review highlights some recent trends in CDSS, including where improvement in patient outcomes was achieved, as well as areas where the benefits were not realized. Overall, three categories of CDSS improving patient safety have been analyzed. These include reduction in adverse events relating to medications, helping facilitate antimicrobial stewardship, and the identification and treatment of pediatric sepsis. In each of these areas, CDSS has been generally shown to improve patient safety to varying degrees. Occasional studies have shown no improvement or worsening outcomes, although this is often due to poor training of clinicians with the technology rather than a flaw with the technology itself. Most CDSS research has been unable to show improvements in tangible outcomes such as mortality rates, but this is often secondary to the fact that these outcomes are rare in the pediatric context and thus showing improvements is challenging. CDSS is a simple term to describe a heterogenous group of interventions, designed to improve patient care using technology. In this review, the evidence shows that it can improve adherence to antimicrobial guidelines, minimize medication errors, and improve identification of pediatric sepsis. Like any new system, when implemented cautiously, with ample time for education of staff and troubleshooting, it can improve patient safety; however, if not implemented with sufficient forethought, it may not improve safety and can indeed cause its own adverse events.