Performance and Utilization of an Emergency Department Electronic Screening Tool for Pneumonia | Clinical Decision Support | JAMA Internal Medicine | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Tversky A, Kahneman D. The framing of decisions and the psychology of choice.  Science. 1981;211(4481):453-4587455683PubMedGoogle ScholarCrossref
Dean NC, Jones JP, Aronsky D,  et al.  Hospital admission decision for patients with community-acquired pneumonia: variability among physicians in an emergency department.  Ann Emerg Med. 2012;59(1):35-4121907451PubMedGoogle ScholarCrossref
Vines CJ, Dean NC. Technology implementation impacting the outcomes of patients with CAP.  Semin Respir Crit Care Med. 2012;33(3):292-29722718215PubMedGoogle ScholarCrossref
Dean NC, Silver MP, Bateman KA, James B, Hadlock CJ, Hale D. Decreased mortality after implementation of a treatment guideline for community-acquired pneumonia.  Am J Med. 2001;110(6):451-45711331056PubMedGoogle ScholarCrossref
Aronsky D, Haug PJ. Diagnosing community-acquired pneumonia with a Bayesian network.  Proc AMIA Symp. 1998;11(3):632-6369929296PubMedGoogle Scholar
Mandell LA, Wunderink RG, Anzueto A,  et al; Infectious Diseases Society of America; American Thoracic Society.  Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults.  Clin Infect Dis. 2007;44:(suppl 2)  S27-S7217278083PubMedGoogle ScholarCrossref
Begg CB, Greenes RA. Assessment of diagnostic tests when disease verification is subject to selection bias.  Biometrics. 1983;39(1):207-2156871349PubMedGoogle ScholarCrossref
Ash JS, Sittig DF, Campbell EM, Guappone KP, Dykstra RH. Some unintended consequences of clinical decision support systems.  AMIA Annu Symp Proc. 2007;Oct 11:26-3018693791PubMedGoogle Scholar
Research Letter
April 22, 2013

Performance and Utilization of an Emergency Department Electronic Screening Tool for Pneumonia

Author Affiliations

Author Affiliations: Division of Pulmonary and Critical Care Medicine (Drs Dean and Jones) and Emergency Department (Dr Vines), Intermountain Medical Center, and Department of Internal Medicine, University of Utah (Drs Dean and Jones), Salt Lake City; and Homer Warner Center for Informatics Research, Salt Lake City, Utah (Mr Ferraro and Dr Haug).

JAMA Intern Med. 2013;173(8):699-701. doi:10.1001/jamainternmed.2013.3299

Appropriate treatment of pneumonia begins with accurate diagnosis. However, clinicians have difficulty integrating data for clinical decision making.1 Significant variability in pneumonia management exists in the emergency department (ED).2 Decision support might decrease variability and improve care, but physician utilization is historically low.3 An alerting tool is needed for physicians to utilize computer-based pneumonia decision support.

We developed a real-time electronic screening tool that identifies patients with pneumonia by applying Bayesian probabilistic logic to the electronic medical record, and we implemented the tool in 4 EDs. A “P” appears on the ED electronic tracker board when pneumonia likelihood reaches 40%. Clicking on the icon displays pneumonia likelihood and the relevant data (Figure). After confirming the diagnosis, the ED physician proceeds with a linked decision support tool that provides management recommendations.