Background:
Hospitalized patients deserve medical care that is based on the latest scientific evidence. Numerous sources reveal a very different reality with unexplained variation in practice and widespread problems of quality and safety.
Standard order sets for common hospital diagnoses are useful tools for the application of evidence‐based care that can reduce medical errors and simplify the work of clinicians. Many physicians resist the use of these order sets because of concerns about cookbook medicine and loss of professional autonomy. In many institutions, standard order sets are created and championed by non‐clinical personnel and each order set is based on a separate template. There is a diminished sense of quality by users because of the lack of standardization.
Purpose:
The purpose of this innovation was to create a product of standard order sets for common hospital diagnoses that facilitated the application of evidence‐based recommendations for every day practice. The goal was to produce user‐friendly standard order sets that were customized by diagnosis. The principles of mass customization were drafted to achieve this goal.
Description:
Mass customization is the manufacturing process of mass‐producing products that are customized and differentiated for individual use. A principle of mass customization is the use of standard parts that can be adapted for product differentiation using modules or through building knowledge so as to predict the most likely choices of customers.
Creating the product of standard order sets began with a standardized order template. This standardized template was based on the pneumonic device learned by third year medical students for writing admission orders of ADCVANDIML: admit to, diagnosis, condition, vital signs, activity, nursing orders, diet, intravenous fluids, medications, and labs.
Using this basic, familiar pattern for a general order set allowed for further differentiation by diagnosis using mass customization to differentiate each of the order sets. The following options were applied to adapt the order sets for different diagnoses: lab tests, imaging studies, core measures, ancillary services, patient education goals, consultants, and medications.
Summary of Results:
A basic product of General Admission Orders was created from the ADCVANDIML format. Using the principles of mass customization, differentiated order sets for CHF, UTI, TIA, stroke, ACS, COPD exacerbations, and pneumonia were adapted and differentiated from the basic template. Each of the custom order sets kept the framework of the basic template therefore clinicians only have to get use to using one order set. The result was evidence‐based standard order sets that were user friendly. The quality perception of the user was increased by the customization to unique circumstances. The basic template can be further adapted for an unlimited number of diagnoses.
Author Disclosure Block:
P.J. Torcson, None; C.A. Seicshnaydre, None; J.R. Bobrowski, None; E.R. Ehrensing, None.