Effect of near real-time feedback tool in the electronic medical record on protocol compliance during laparoscopic cholecystectomy: a single-center retrospective analysis

Implementation of evidence-based medicine has proved difficult across medical fields. Leveraging the electronic medical record may improve clinician compliance to published best practices. Our hypothesis was that the use of a near real-time feedback tool would improve compliance to the protocol steps. In order to test this hypothesis, we performed a retrospective chart review to compare compliance to a proprietary enhanced recovery protocol for patients undergoing laparoscopic cholecystectomy with and without a near real-time feedback tool embedded in the electronic medical record. Deviations to the care pathway were quantified and classified as allowable or as errors of commission, omission, or dose. During the study period, 2625 laparoscopic cholecystectomies were performed. A total of 16,972 protocol steps were evaluated. Complete protocol compliance improved from 10.3 to 61.5% (p < 0.001) with the use of the feedback tool. Individual protocol component compliance increased from 4994/8418 (59.3%) to 7669/8554 (89.7%) (p < 0.001). The near real-time feedback tool reduced the number of cases with every number of deviations (except zero) at p < 0.001. The near real-time feedback tool significantly improved protocol compliance for patients undergoing laparoscopic cholecystectomy.