Why don’t physicians use order sets? Identifying opportunities and challenges

Feb 20, 2017 - 12:00pm to 1:00pm
700-828 W. 10 Ave., VGH Research Pavilion
Bryn Lander

Tens if not hundreds of published papers show that clinicians do not follow guidelines. Few of these studies assess how guidelines and other forms of evidence are incorporated into a clinician’s daily work. Within Vancouver, resources have been expended to develop and implement order sets as a tool to increase guideline adherence. The idea behind this is intuitively appealing. An order set is a form where guideline recommendations are translated into a series of check boxes and fill-in-the-blanks that clinicians use when writing orders for a specific condition. Within Vancouver order set use has been inconsistent and, in many cases, disappointingly low.

In this presentation I will discuss results from a project focused on understanding order set use and its connection to evidence-based practice. I developed the project in collaboration with an advisory committee comprised of health administrators, hospital managers, and clinicians. I used a mixed methods approach that combined shadowing care workers (over 265 hours) with patient chart audits (n=240). I studied general workflows and care as well as the use of three order sets—related to chronic obstructive pulmonary, congestive heart failure, and sepsis—by internal medicine teams at two academic medical centers.  

The presentation sets out to explore:

  • how order sets are incorporated into workflows, diagnostics, and care decisions;
  • issues and challenges arising in the use of orders sets, including reasons staff do not use order sets when they are available; and
  • how order sets are used and their connection to evidence-based practice.