BMC Med Inform Decis Mak - Reducing unnecessary testing in a CPOE system through implementation of a targeted CDS intervention.

Tópicos

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Resumo

CKGROUND: We describe and evaluate the development and use of a Clinical Decision Support (CDS) intervention; an alert, in response to an identified medical error of overuse of a diagnostic laboratory test in a Computerized Physician Order Entry (CPOE) system. CPOE with embedded CDS has been shown to improve quality of care and reduce medical errors. CPOE can also improve resource utilization through more appropriate use of laboratory tests and diagnostic studies. Observational studies are necessary in order to understand how these technologies can be successfully employed by healthcare providers.METHODS: The error was identified by the Test Utilization Committee (TUC) in September, 2008 when they noticed critical care patients were being tested daily, and sometimes twice daily, for B-Type Natriuretic Peptide (BNP). Repeat and/or serial BNP testing is inappropriate for guiding the management of heart failure and may be clinically misleading. The CDS intervention consists of an expert rule that searches the system for a BNP lab value on the patient. If there is a value and the value is within the current hospital stay, an advisory is displayed to the ordering clinician. In order to isolate the impact of this intervention on unnecessary BNP testing we applied multiple regression analysis to the sample of 41,306 patient admissions with at least one BNP test at LVHN between January, 2008 and September, 2011.RESULTS: Our regression results suggest the CDS intervention reduced BNP orders by 21% relative to the mean. The financial impact of the rule was also significant. Multiplying by the direct supply cost of $28.04 per test, the intervention saved approximately $92,000 per year.CONCLUSIONS: The use of alerts has great positive potential to improve care, but should be used judiciously and in the appropriate environment. While these savings may not be generalizable to other interventions, the experience at LVHN suggests that appropriately designed and carefully implemented CDS interventions can have a substantial impact on the efficiency of care provision.

Resumo Limpo

ckground describ evalu develop use clinic decis support cds intervent alert respons identifi medic error overus diagnost laboratori test computer physician order entri cpoe system cpoe embed cds shown improv qualiti care reduc medic error cpoe can also improv resourc util appropri use laboratori test diagnost studi observ studi necessari order understand technolog can success employ healthcar providersmethod error identifi test util committe tuc septemb notic critic care patient test daili sometim twice daili btype natriuret peptid bnp repeat andor serial bnp test inappropri guid manag heart failur may clinic mislead cds intervent consist expert rule search system bnp lab valu patient valu valu within current hospit stay advisori display order clinician order isol impact intervent unnecessari bnp test appli multipl regress analysi sampl patient admiss least one bnp test lvhn januari septemb result regress result suggest cds intervent reduc bnp order relat mean financi impact rule also signific multipli direct suppli cost per test intervent save approxim per yearconclus use alert great posit potenti improv care use judici appropri environ save may generaliz intervent experi lvhn suggest appropri design care implement cds intervent can substanti impact effici care provis

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