Abstract

Objective

While the judicious use of antibiotics takes past microbiological culture results into consideration, this data’s typical format in the electronic health record (EHR) may be unwieldy when incorporated into clinical decision-making. We hypothesize that a visual representation of sensitivities may aid in their comprehension.

Materials and Methods

A prospective parallel unblinded randomized controlled trial was undertaken at an academic urban tertiary care center. Providers managing emergency department (ED) patients receiving antibiotics and having previous culture sensitivity testing were included. Providers were randomly selected to use standard EHR functionality or a visual representation of patients’ past culture data as they answered questions about previous sensitivities. Concordance between provider responses and past cultures was assessed using the kappa statistic. Providers were surveyed about their decision-making and the usability of the tool using Likert scales.

Results

518 ED encounters were screened from 3/5/2018 to 9/30/18, with providers from 144 visits enrolled and analyzed in the intervention arm and 129 in the control arm. Providers using the visualization tool had a kappa of 0.69 (95% CI: 0.65–0.73) when asked about past culture results while the control group had a kappa of 0.16 (95% CI: 0.12–0.20). Providers using the tool expressed improved understanding of previous cultures and found the tool easy to use (P < .001). Secondary outcomes showed no differences in prescribing practices.

Conclusion

A visual representation of culture sensitivities improves comprehension when compared to standard text-based representations.

中文翻译：

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微生物培养数据的可视化表示提高了理解能力：一项随机对照试验

摘要

客观的

虽然明智地使用抗生素会考虑过去的微生物培养结果，但电子健康记录 (EHR) 中的这些数据的典型格式在纳入临床决策时可能难以处理。我们假设敏感性的视觉表示可能有助于他们的理解。

材料和方法

在一个学术型城市三级护理中心进行了一项前瞻性平行非盲随机对照试验。包括管理接受抗生素和以前进行过培养敏感性测试的急诊科 (ED) 患者的提供者。提供者被随机选择使用标准 EHR 功能或患者过去文化数据的可视化表示，因为他们回答了有关先前敏感性的问题。使用 kappa 统计量评估提供者响应与过去文化之间的一致性。使用李克特量表对提供者进行了关于他们的决策和工具可用性的调查。

结果

从 2018 年 3 月 5 日到 2018 年 9 月 30 日，筛查了 518 次 ED 就诊，干预组和对照组分别登记和分析了 144 次就诊的提供者和 129 次。当被问及过去的培养结果时，使用可视化工具的提供者的 kappa 为 0.69（95% CI：0.65-0.73），而对照组的 kappa 为 0.16（95% CI：0.12-0.20）。使用该工具的提供者表达了对以前文化的更好理解，并发现该工具易于使用 ( P  < .001)。次要结果显示处方实践没有差异。

结论

与标准的基于文本的表示相比，文化敏感性的视觉表示提高了理解力。