Special Issue on CDS Failures: Clinical Decision Support to Reduce Hospital Length-of-Stay for Cancer Patients with Fever and Neutropenia.

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 new validated scoring system, a subset of these patients is at lower risk and eligible for early discharge and reduced 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: Post-implementation, 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.