Scenarios

CDS takes many forms, and can be used in a wide variety of circumstances and settings where additional information pertinent to the current clinical situation can help inform better decisions. Thefollowing scenarios depict examples of the use of CDS in environments that range from high-acuity inpatient care to ambulatory and chronic disease management. The CDS Types correspond to the list of ten CDS Intervention Types shown on the CDS Fundamental Issues page.

Scenario A
You are a nurse on a busy med-surg unit in an acute care hospital. Every time you administer a medication, you are required to scan the bar codes of your patient’s wristband and the medication. Occasionally, this process prompts an alert (CDS Type: Critiques and Warnings) that the medication you are about to administer is contraindicated for your patient at this time. You contact the attending physician to communicate this and obtain an order for an alternate medication.

Scenario B
You are a primary care physician in a large group practice that uses an electronic health record (EHR). At the beginning of each visit, you view a dashboard (CDS Type: Relevant Data Summary) of preventive care measures - such as flu vaccine, colon cancer screening, cholesterol tests - that are due for your patient, based on age, medical history (problem list), and medication list stored in the EHR.

Scenario C
You are a care manager in an emergency department. Thirty patients are in the unit right now, and new lab results, imaging studies, and orders are constantly being posted on all of them. You have a visual "air traffic" tracking display (CDS Type: Multi-Patient Monitor) which indicates which patients have not been seen yet, which have new orders to process, which have abnormal lab results, which ones have been in the unit more than four hours, which have inpatient beds ready, and more. Your status display filters and reformats all the information to help you know where to direct your attention next.

Scenario D
You are an attending physician in an urban emergency department. A 60 year old male presents complaining of pain and swelling in the right leg. Upon examination, you observe red discoloration on the surface of the right calf with the appearance of visible surface veins. Suspecting a possible deep vein thrombosis (DVT), you prepare to admit the patient and go to order heparin.  When you choose the DVT order set In the CPOE system (CDS Type: Order Sets/Care Plans/Protocols), it highlights a link to an updated American College of Chest Physicians guideline (CDS Type: Filtered Reference Information and Knowledge Resources), which suggests that low-molecular-weight heparin may be a better medication for certain patients. After reading the new information, you decide to change from heparin to enoxaparin, and another option in the order set facilitates the proper dosing of the new medication.

Scenario E
You are an ICU physician. You are in your office at the hospital and you receive vital signs trends on your patients using your smart phone. You set a “smart alert” on a particular elderly patient on mechanical ventilation whom you suspect may be prone to sepsis (CDS Type: Event-Driven Alert). You are notified of the vital signs trends on your patient which show, among other parameters, a noticeable increase in temperature and heart rate over the past hour and decreasing urine output, as indicated from the Intake and Output accumulations. You call the unit to verify these data, and decide to access the CPOE system to order stat blood tests to confirm the onset of sepsis, and you also start antibiotics. The EMR notifies you that your patient is allergic to one of the particular antibiotics you were originally ordering (CDS Type: Critiques and Warnings), so you select one that has no contraindications.