Dataset Information

Coronavirus Disease 2019 (COVID-19) Diagnostic Clinical Decision Support: A Pre-Post Implementation Study of CORAL (COvid Risk cALculator).

ABSTRACT:

Background

Isolation of hospitalized persons under investigation (PUIs) for coronavirus disease 2019 (COVID-19) reduces nosocomial transmission risk. Efficient evaluation of PUIs is needed to preserve scarce healthcare resources. We describe the development, implementation, and outcomes of an inpatient diagnostic algorithm and clinical decision support system (CDSS) to evaluate PUIs.

Methods

We conducted a pre-post study of CORAL (COvid Risk cALculator), a CDSS that guides frontline clinicians through a risk-stratified COVID-19 diagnostic workup, removes transmission-based precautions when workup is complete and negative, and triages complex cases to infectious diseases (ID) physician review. Before CORAL, ID physicians reviewed all PUI records to guide workup and precautions. After CORAL, frontline clinicians evaluated PUIs directly using CORAL. We compared pre- and post-CORAL frequency of repeated severe acute respiratory syndrome coronavirus 2 nucleic acid amplification tests (NAATs), time from NAAT result to PUI status discontinuation, total duration of PUI status, and ID physician work hours, using linear and logistic regression, adjusted for COVID-19 incidence.

Results

Fewer PUIs underwent repeated testing after an initial negative NAAT after CORAL than before CORAL (54% vs 67%, respectively; adjusted odd ratio, 0.53 [95% confidence interval, .44-.63]; P < .01). CORAL significantly reduced average time to PUI status discontinuation (adjusted difference [standard error], -7.4 [0.8] hours per patient), total duration of PUI status (-19.5 [1.9] hours per patient), and average ID physician work-hours (-57.4 [2.0] hours per day) (all P < .01). No patients had a positive NAAT result within 7 days after discontinuation of precautions via CORAL.

Conclusions

CORAL is an efficient and effective CDSS to guide frontline clinicians through the diagnostic evaluation of PUIs and safe discontinuation of precautions.

SUBMITTER: Dugdale CM

PROVIDER: S-EPMC7929052 | biostudies-literature | 2021 Dec

REPOSITORIES: biostudies-literature

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Publications

Coronavirus Disease 2019 (COVID-19) Diagnostic Clinical Decision Support: A Pre-Post Implementation Study of CORAL (COvid Risk cALculator).

Dugdale Caitlin M CM Rubins David M DM Lee Hang H McCluskey Suzanne M SM Ryan Edward T ET Kotton Camille N CN Hurtado Rocio M RM Ciaranello Andrea L AL Barshak Miriam B MB McEvoy Dustin S DS Nelson Sandra B SB Basgoz Nesli N Lazarus Jacob E JE Ivers Louise C LC Reedy Jennifer L JL Hysell Kristen M KM Lemieux Jacob E JE Heller Howard M HM Dutta Sayon S Albin John S JS Brown Tyler S TS Miller Amy L AL Calderwood Stephen B SB Walensky Rochelle P RP Zachary Kimon C KC Hooper David C DC Hyle Emily P EP Shenoy Erica S ES

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 20211201 12

<h4>Background</h4>Isolation of hospitalized persons under investigation (PUIs) for coronavirus disease 2019 (COVID-19) reduces nosocomial transmission risk. Efficient evaluation of PUIs is needed to preserve scarce healthcare resources. We describe the development, implementation, and outcomes of an inpatient diagnostic algorithm and clinical decision support system (CDSS) to evaluate PUIs.<h4>Methods</h4>We conducted a pre-post study of CORAL (COvid Risk cALculator), a CDSS that guides frontli ...[more]

PMID: 33564833

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Dataset Information

Coronavirus Disease 2019 (COVID-19) Diagnostic Clinical Decision Support: A Pre-Post Implementation Study of CORAL (COvid Risk cALculator).

Background

Methods

Results

Conclusions

Publications

Coronavirus Disease 2019 (COVID-19) Diagnostic Clinical Decision Support: A Pre-Post Implementation Study of CORAL (COvid Risk cALculator).

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