Clinical Decision Support Intervention for Rib Fracture Treatment

J Am Coll Surg. 2020 Aug;231(2):249-256.e2. doi: 10.1016/j.jamcollsurg.2020.04.023. Epub 2020 Apr 30.


Background: Rib fractures are associated with significant morbidity and mortality. Despite the publication of management guidelines and national outcomes benchmarking, there is significant variation in evidence-based (EB) adherence and outcomes. Systems for clinical decision support intervention (CDSI) allow rapid ordering of bundled disease-specific EB treatments. We developed an EB rib fracture protocol and CDSI at our institution. The purpose of the current study was to evaluate implementation and clinical outcomes using this CDSI.

Study design: A rib fracture care CDSI was developed, disseminated, and implemented in July 2018. Implementation outcomes were evaluated using the Proctor framework. Adherence was tracked monthly via run charts and acceptance was evaluated on a 7-point Likert scale using the Unified Theory of Acceptance and Use of Technology questionnaire. Propensity score matching was used to compare in-hospital morbidity and mortality in pre-implementation (January 1, 2016 through December 31, 2016) vs post-implementation (September 1, 2018 through April 30, 2019) cohorts.

Results: A total of 197 patients were eligible for the intervention. Provider CDSI adherence was 83% at 1 month and reached 100% after 7 months. Acceptance of CDSI using the Unified Theory of Acceptance and Use of Technology had a mean Likert score higher than 6 (range 6.1 to 6.8, SD 0.5 to 1.5), indicating high acceptance. A significant reduction in hospital length of stay was found post implementation (incident rate ratio 0.80; 95% CI, 0.66 to 0.98; p = 0.03) comparing propensity-matched subjects.

Conclusions: The development and use of a CDSI resulted in improved provider delivery of EB practice and was associated with reduced hospital length of stay.

Publication types

  • Clinical Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Clinical Protocols
  • Decision Support Systems, Clinical*
  • Electronic Health Records
  • Female
  • Guideline Adherence / statistics & numerical data
  • Hospital Mortality
  • Humans
  • Length of Stay / statistics & numerical data
  • Logistic Models
  • Male
  • Middle Aged
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / statistics & numerical data
  • Propensity Score
  • Quality Improvement / statistics & numerical data
  • Rib Fractures / complications
  • Rib Fractures / mortality
  • Rib Fractures / therapy*
  • Treatment Outcome