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Appl Clin Inform 2025; 16(03): 538-543
DOI: 10.1055/a-2540-2349
Special Issue on CDS Failures

Clinical Decision Support to Reduce Hospital Length-of-Stay for Cancer Patients with Fever and Neutropenia

Julia KW Yarahuan
1   Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States
2   Department of Information Systems and Technology, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
3   Division of Hospital Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
,
Swaminathan Kandaswamy
1   Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States
,
Edwin Ray
2   Department of Information Systems and Technology, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
,
Rachael Leroux
4   Aflac Cancer & Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, Georgia, United States
,
Wayne H. Liang
1   Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States
2   Department of Information Systems and Technology, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
4   Aflac Cancer & Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, Georgia, United States
,
Evan Orenstein
1   Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States
2   Department of Information Systems and Technology, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
3   Division of Hospital Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
,
Claire L. Stokes
1   Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States
4   Aflac Cancer & Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, Georgia, United States
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Abstract

Background

Pediatric cancer patients with fever and neutropenia are at risk for bacterial sepsis, traditionally requiring extended hospital stays on antibiotics until neutrophil counts recover. According to a newly validated scoring system, a subset of these patients is at lower risk and eligible for early discharge and reduced intravenous (IV) antibiotic exposure.

Objective

Reduce length-of-stay (LOS) for febrile neutropenic patients using clinical decision support (CDS) to identify low-risk patients.

Methods

A CDS system was developed to (1) screen febrile neutropenic patients using a validated clinical decision rule, (2) surface when low-risk patients become eligible for discharge, and (3) facilitate close phone follow-up for patients discharged early. The system was implemented in March 2023 and iteratively refined based on usability testing.

Results

Postimplementation, LOS did not improve significantly, and uptake of the CDS tool remained low. Though the tool had the potential to reduce LOS, the limited staff engagement was a significant barrier to success. Safety outcomes, including ICU readmissions and mortality, remained unaffected.

Conclusion

Despite carefully designed CDS applying an evidence-based scoring system and using human-centered design methodology, the failure to achieve the desired reduction in LOS was primarily due to insufficient uptake by clinical staff. This highlights the need for stronger strategies to ensure clinician engagement and integration into workflows for CDS tools to be effective.

Keywords

clinical decision support - pediatrics - electronic health records and systems

Protection of Human and Animal Subjects

This study was part of the Quality Improvement Initiative and was deemed nonhuman subjects by the Children's Healthcare of Atlanta Institutional Review Board.




Publication History

Received: 09 December 2024

Accepted: 16 February 2025

Accepted Manuscript online:
18 February 2025

Article published online:
11 June 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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