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CC BY-NC-ND 4.0 · ACI open 2022; 06(02): e98-e102
DOI: 10.1055/s-0042-1758074
Case Report

Rapid Prototyping and Implementation of Electronic Order Sets for Critically Ill Adults with COVID-19 Admitted to a Children's Hospital

Authors

  • Nicole K. McKinnon

    1   Department of Critical Care Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
    2   Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
    3   Neuroscience and Mental Health, Research Institute, Sickkids, Toronto, Canada

  • Shawna Silver

    2   Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
    4   Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada

  • Sandra Pong

    5   Department of Pharmacy, Hospital for Sick Children, Toronto, Ontario, Canada

  • Winnie Seto

    5   Department of Pharmacy, Hospital for Sick Children, Toronto, Ontario, Canada

  • Phoebe Chan

    5   Department of Pharmacy, Hospital for Sick Children, Toronto, Ontario, Canada

  • Elaine Gilfoyle

    1   Department of Critical Care Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
    2   Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
    6   Child Health Evaluative Science, Research Institute, Sickkids, Toronto, Canada

  • Karim Jessa

    2   Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
    4   Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada

  • Seth B. Gray

    1   Department of Critical Care Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
    2   Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

Funding None.
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Abstract

Objectives An eight-bed adult coronavirus (COVID-19) critical care (CC) unit was established within our pediatric CC unit (PCCU) when SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) variants increased the CC bed demand. Our objective was to rapidly implement electronic order sets (OSs) to facilitate computerized provider order entry (CPOE) for adult patients admitted within a children's hospital.

Methods OS development began from the assessment of OSs from seven adult CC units. Using a pre-existing PCCU admission template, we created two OSs: adult COVID-19 admission and ongoing care. We tested the prototypes in a multidisciplinary onsite–virtual hybrid tabletop simulation to evaluate usability within established workflows. Participants utilized role-specific profiles within the electronic health record (EHR) training environment which paralleled their computer interface, permitting charting and documentation. EHR analysts were present to gather change requests. Following implementation, we performed twice-daily huddles with end users to identify issues.

Results A total of 13 multidisciplinary bedside providers participated in simulation testing of the prototypes. Two safety issues were addressed before implementation. The electronic OSs were developed, tested, and implemented within 8 days. The postimplementation huddles identified one medication addition, and no deletions were necessary.

Conclusion Caring for adult COVID-19 patients within a freestanding children's hospital presents challenges and has the potential to introduce latent safety threats. Rapid development and implementation of electronic OSs within 8 days to facilitate CPOE and reduce health care provider cognitive burden relied on leveraging functionality within the EMR system, performing iterative testing with a tabletop simulation, integration into previously established workflows, and gathering post-implementation feedback for continuous improvement.

Keywords

clinical decision support - process management tools - specific types - clinical information systems, testing and evaluation - general aspects

Clinical Relevance Statement

The COVID-19 pandemic highlighted the need to be able to rapidly increase CC bed capacity, including having flexibility to admit adult patients to children's hospitals. Future situations may evolve when similar flexibility is required and this article describes the rapid development, testing, and implementation of electronic OSs to facilitate CPOE and provide clinical decision support for non-standard patients, with a focus on patient safety and decreasing caregiver cognitive burden.


Protection of Human and Animal Subjects

We reviewed this case report with our quality improvement specialists, and they deemed this case report to not meet criteria of human subject research.


Supplementary Material



Publication History

Received: 15 February 2022

Accepted: 10 July 2022

Article published online:
09 December 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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