Improving Evidenced-based Outpatient Order Set Utilization in the Gastrointestinal Division of a Large Pediatric Health System.

Abstract

Introduction: Standardization is crucial in improving healthcare outcomes, equity and quality. Clinical decision support tools are key to achieving this goal. At our organization, Epic serves as our electronic health record, and SmartSets are Epic's version of outpatient standardized order sets with embedded clinical decision support tools. In 2022, the utilization of SmartSets in our hospital's gastrointestinal division was only 1.9%, far below our organizational target of 50%.

Methods: Our group formed a quality improvement (QI) team and chose the model for improvement methodology. The interventions focused on education, buy-in, feedback performance monitoring, and the enhancement and development of new SmartSets. Our primary aim was to increase the utilization rate of SmartSets by gastrointestinal providers from 1.9% to 20%, and our secondary aim was to reduce the time spent by providers on orders by 10% from 3.3 to 2.8 minutes per encounter. Our balancing measure was monitoring safety reports during the study period.

Results: SmartSet utilization improved to greater than 20% within 7 months of the project initiation. Three months after implementing SmartSet updates and introducing new SmartSets into production, time spent on orders during clinical encounters decreased from a median of 3.3 to 2.4 minutes per encounter. We appreciated that there was no change in safety reporting during the project timeline.

Conclusions: We achieved our goal of improving utilization rates of standardized SmartSets and reducing time spent on orders using a QI methodology. Our achievements underscore the effectiveness of QI methods in enhancing SmartSet utilization and streamlining order processes.