TECHNOLOGY


coroner inquest, the doctor will be asked which guideline they followed. From this point of view, the recommendation of an evidence-based CDS tool can be perfectly adequate, as can documentation to show that the consultant sought expert advice from specialist colleagues.


Reducing errors, boosting education However, although highly useful for senior doctors like myself, CDS can also support junior doctors in two main areas: reducing errors and education. Taking error reduction first, we carried out a study at UHL with the aim to improve junior doctors’ performance. The project was piloted here in response to a General Medical Council study that confirmed how many newly qualified junior doctors struggle with complex clinical decision-making and make prescribing errors at up to twice the rate of other health professionals. The eight-month pilot scheme aimed to increase prescribing competence, performance and safety behaviour. It challenged junior doctors to take ownership and responsibility for problem-solving and decision-making. As part of the project, the junior doctors were given access to CDS, in this case UpToDate. The results spoke for themselves – there was a 50% reduction in prescription errors, prescribing competence increased by 106%, most serious errors were eradicated, doctors felt better supported and patients reported being happier with care. The potential cost saving from avoiding medication errors was £300,000, and the junior doctors reported they were more confident and felt more supported in their work. With regard to education, the right CDS tools can be important tools for younger doctors. For example, we often see junior doctors using resources that deliver bite-sized information to direct their decisions, rather than digesting more detailed information to support a professional judgement. As they will be the next-generation of decision- makers, I think there is a good case for encouraging the routine use of Trust- approved CDS tools by junior doctors. It’s good to get it into their habits early on, as it will become an increasingly accepted – and expected – way of working. CDS can also play an important part in Continuous Professional Development (CPD), especially when it’s used as part of a workplace-based assessment (WPBA). As part of their WPBAs, a junior doctor will be asked to assess a patient and their symptoms, make a plan and then present a case to the registrar or consultant. The senior doctor assesses how the junior has managed the patient, reviewing all aspects of care. As an educational supervisor, I would


FEBRUARY 2021


look at their WPBAs concerning a particular condition or symptoms and I would ask them to provide evidence that they have read about this condition. CDS can provide this evidence, if they can provide the proof that they logged into UpToDate and spent time looking at the information.


Cutting trial-and-error testing There are other reasons why CDS is playing a bigger role in the NHS. A significant one is that it is an effective tool for increasing efficiency and reducing variation in care, which are two priorities across the health service. As clinicians, we are often faced with complex cases and it’s tempting to request a lot of tests to make sure we cover all eventualities to reach the right diagnosis. CDS can help to reduce the trial and error approach to testing. The technology can often suggest tests that I may not have initially considered, which can set you on the right pathway faster. More efficient and accurate testing saves time and money throughout the Trust, including fewer outpatient appointments. This, in turn, can also help to alleviate variations in care, as clinicians go down the right pathways faster and follow recommended procedures. This is true not only in my own practice, but across specialties and hospitals where clinical decision support is used.


Decision-making in virtual care Most recently, the impact of the COVID-19 pandemic has created a new role for CDS, as hospitals make the shift to virtual consultations.The more I do virtual consultations – and they are now the default option – the more I see an opportunity for patients to be engaged with information about their conditions. That’s far easier in a virtual consultation, when I can be looking at my screen to consult information sources and share information with the patient. Working remotely also means my time


is not limited in the same way as used to be in the consulting room. This means I can prepare better for each consultation. In the past, I would look at my previous letter about a patient and that was it. Now, before I see the patient, I can open the patient’s GP record, laboratory system, radiology system, and also my previous notes. If I’m not sure about the plan of action, I can use the CDS to support my decision-making. All of this means I can hit the ground running with the patient, which makes the consultation much more efficient from both perspectives. Ultimately, when we consider the case for CDS and other supporting technology, it’s important to remember a simple truth: we shouldn’t be flying by the seat of our pants in medicine. All clinicians should be seeking the advice of fellow experts to make sure we do the right thing. Those experts can be specialist colleagues, or the clinicians who develop CDS resources.


CSJ


About the author


Dr. Stephen Jackson, is a consultant physician in Diabetes and Endocrinology and chief medical information officer at University Hospitals of Leicester NHS Trust – one of the largest and busiest teaching Trusts in England.


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