Development of a clinical decision support system for living kidney donor assessment based on national guidelines

<strong>Background:</strong> Live donor nephrectomy is an operation that places the donor at risk of complications without the possibility of medical benefit. Rigorous donor selection and assessment is therefore essential to ensure minimisation of risk and for this reason robust nationa...

Ful tanımlama

Detaylı Bibliyografya
Asıl Yazarlar: Knight, SR, Cao, K, South, M, Hunter, J, Hayward, N, Fox, J
Materyal Türü: Journal article
Baskı/Yayın Bilgisi: Lippincott, Williams and Wilkins 2018
_version_ 1826280552992342016
author Knight, SR
Cao, K
South, M
Hunter, J
Hayward, N
Fox, J
author_facet Knight, SR
Cao, K
South, M
Hunter, J
Hayward, N
Fox, J
author_sort Knight, SR
collection OXFORD
description <strong>Background:</strong> Live donor nephrectomy is an operation that places the donor at risk of complications without the possibility of medical benefit. Rigorous donor selection and assessment is therefore essential to ensure minimisation of risk and for this reason robust national guidelines exist. Previous studies have demonstrated poor adherence to donor guidelines. <br/> <strong>Methods:</strong> We developed a clinical decision support system (CDSS), based upon national living donor guidelines, to facilitate the identification of contraindications, additional investigations, special considerations and the decision as to nephrectomy side in potential living donors. The CDSS was then tested with patient data from 45 potential kidney donors. <br/> <strong>Results:</strong> The CDSS comprises 17 core tasks completed by either patient or nurse, and 17 optional tasks that are triggered by certain patient demographics or conditions. Decision rules were able to identify contraindications, additional investigations, special considerations and predicted operation side in our patient cohort. 17/45 patients went on to donate a kidney, of whom 7 had major contraindications defined in the national guidelines, many of which were not identified by the clinical team. Only 43% of additional investigations recommended by national guidelines were completed, with the most frequently missed investigations being oral glucose tolerance testing and routine cancer screening. <br/> <strong>Conclusions: </strong>We have demonstrated the feasibility of turning a complex set of national guidelines into an easy-to-use machine-readable CDSS. Comparison with real-world decisions suggests that use of this CDSS may improve compliance with guidelines and informed consent tailored to individual patient risks.
first_indexed 2024-03-07T00:15:24Z
format Journal article
id oxford-uuid:7aaab70e-d56c-40cb-a84f-85c60a5165af
institution University of Oxford
last_indexed 2024-03-07T00:15:24Z
publishDate 2018
publisher Lippincott, Williams and Wilkins
record_format dspace
spelling oxford-uuid:7aaab70e-d56c-40cb-a84f-85c60a5165af2022-03-26T20:45:29ZDevelopment of a clinical decision support system for living kidney donor assessment based on national guidelinesJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:7aaab70e-d56c-40cb-a84f-85c60a5165afSymplectic Elements at OxfordLippincott, Williams and Wilkins2018Knight, SRCao, KSouth, MHunter, JHayward, NFox, J <strong>Background:</strong> Live donor nephrectomy is an operation that places the donor at risk of complications without the possibility of medical benefit. Rigorous donor selection and assessment is therefore essential to ensure minimisation of risk and for this reason robust national guidelines exist. Previous studies have demonstrated poor adherence to donor guidelines. <br/> <strong>Methods:</strong> We developed a clinical decision support system (CDSS), based upon national living donor guidelines, to facilitate the identification of contraindications, additional investigations, special considerations and the decision as to nephrectomy side in potential living donors. The CDSS was then tested with patient data from 45 potential kidney donors. <br/> <strong>Results:</strong> The CDSS comprises 17 core tasks completed by either patient or nurse, and 17 optional tasks that are triggered by certain patient demographics or conditions. Decision rules were able to identify contraindications, additional investigations, special considerations and predicted operation side in our patient cohort. 17/45 patients went on to donate a kidney, of whom 7 had major contraindications defined in the national guidelines, many of which were not identified by the clinical team. Only 43% of additional investigations recommended by national guidelines were completed, with the most frequently missed investigations being oral glucose tolerance testing and routine cancer screening. <br/> <strong>Conclusions: </strong>We have demonstrated the feasibility of turning a complex set of national guidelines into an easy-to-use machine-readable CDSS. Comparison with real-world decisions suggests that use of this CDSS may improve compliance with guidelines and informed consent tailored to individual patient risks.
spellingShingle Knight, SR
Cao, K
South, M
Hunter, J
Hayward, N
Fox, J
Development of a clinical decision support system for living kidney donor assessment based on national guidelines
title Development of a clinical decision support system for living kidney donor assessment based on national guidelines
title_full Development of a clinical decision support system for living kidney donor assessment based on national guidelines
title_fullStr Development of a clinical decision support system for living kidney donor assessment based on national guidelines
title_full_unstemmed Development of a clinical decision support system for living kidney donor assessment based on national guidelines
title_short Development of a clinical decision support system for living kidney donor assessment based on national guidelines
title_sort development of a clinical decision support system for living kidney donor assessment based on national guidelines
work_keys_str_mv AT knightsr developmentofaclinicaldecisionsupportsystemforlivingkidneydonorassessmentbasedonnationalguidelines
AT caok developmentofaclinicaldecisionsupportsystemforlivingkidneydonorassessmentbasedonnationalguidelines
AT southm developmentofaclinicaldecisionsupportsystemforlivingkidneydonorassessmentbasedonnationalguidelines
AT hunterj developmentofaclinicaldecisionsupportsystemforlivingkidneydonorassessmentbasedonnationalguidelines
AT haywardn developmentofaclinicaldecisionsupportsystemforlivingkidneydonorassessmentbasedonnationalguidelines
AT foxj developmentofaclinicaldecisionsupportsystemforlivingkidneydonorassessmentbasedonnationalguidelines