Cargando…

Eliminating Amylase Testing from the Evaluation of Pancreatitis in the Emergency Department

BACKGROUND: Alterations in serum biomarkers have been used to evaluate for pancreatitis in the emergency department (ED). Studies have shown lipase to be as sensitive and more specific than amylase in diagnosing pancreatitis and that amylase plus lipase does not improve accuracy over lipase alone. O...

Descripción completa

Detalles Bibliográficos
Autores principales: Volz, Kathryn A., McGillicuddy, Daniel C., Horowitz, Gary L., Wolfe, Richard E., Joyce, Nina, Sanchez, Leon D.
Formato: Texto
Lenguaje:English
Publicado: Department of Emergency Medicine, University of California, Irvine School of Medicine 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2967686/
https://www.ncbi.nlm.nih.gov/pubmed/21079706
_version_ 1782189692303704064
author Volz, Kathryn A.
McGillicuddy, Daniel C.
Horowitz, Gary L.
Wolfe, Richard E.
Joyce, Nina
Sanchez, Leon D.
author_facet Volz, Kathryn A.
McGillicuddy, Daniel C.
Horowitz, Gary L.
Wolfe, Richard E.
Joyce, Nina
Sanchez, Leon D.
author_sort Volz, Kathryn A.
collection PubMed
description BACKGROUND: Alterations in serum biomarkers have been used to evaluate for pancreatitis in the emergency department (ED). Studies have shown lipase to be as sensitive and more specific than amylase in diagnosing pancreatitis and that amylase plus lipase does not improve accuracy over lipase alone. OBJECTIVE: To determine effects of interventions to decrease ordering of amylase in the evaluation of pancreatitis. METHODS: We conducted a pre- and post-cohort study. The number of amylase and lipase tests ordered in the ED was recorded prior to intervention to establish a baseline. We introduced an educational intervention to order lipase without amylase. A second intervention involved removing amylase from bedside order entry forms. We introduced a third intervention that included deleting amylase from trauma order forms, and decoupling amylase and lipase in the computer ordering system. We recorded the number of lipase and amylase tests in weekly aggregates for comparison to the baseline. Data analysis using students t-test, standard deviation and p values are reported. RESULTS: Before interventions 93% of patients had both tests ordered. Educational interventions resulted in a decrease to 91% (p=0.06) of co-ordering. Further interventions decreased the percentage of patients evaluated with both tests to 14.3%. This translates into a decrease in patient charges of approximately $350,000 a year. CONCLUSION: Using simple structured interventions in the ED can reduce amylase ordering. Educational programming alone was not effective in significantly decreasing amylase ordering; however, education plus system-based interventions decreased amylase ordering.
format Text
id pubmed-2967686
institution National Center for Biotechnology Information
language English
publishDate 2010
publisher Department of Emergency Medicine, University of California, Irvine School of Medicine
record_format MEDLINE/PubMed
spelling pubmed-29676862010-11-15 Eliminating Amylase Testing from the Evaluation of Pancreatitis in the Emergency Department Volz, Kathryn A. McGillicuddy, Daniel C. Horowitz, Gary L. Wolfe, Richard E. Joyce, Nina Sanchez, Leon D. West J Emerg Med Emergency Department Administration BACKGROUND: Alterations in serum biomarkers have been used to evaluate for pancreatitis in the emergency department (ED). Studies have shown lipase to be as sensitive and more specific than amylase in diagnosing pancreatitis and that amylase plus lipase does not improve accuracy over lipase alone. OBJECTIVE: To determine effects of interventions to decrease ordering of amylase in the evaluation of pancreatitis. METHODS: We conducted a pre- and post-cohort study. The number of amylase and lipase tests ordered in the ED was recorded prior to intervention to establish a baseline. We introduced an educational intervention to order lipase without amylase. A second intervention involved removing amylase from bedside order entry forms. We introduced a third intervention that included deleting amylase from trauma order forms, and decoupling amylase and lipase in the computer ordering system. We recorded the number of lipase and amylase tests in weekly aggregates for comparison to the baseline. Data analysis using students t-test, standard deviation and p values are reported. RESULTS: Before interventions 93% of patients had both tests ordered. Educational interventions resulted in a decrease to 91% (p=0.06) of co-ordering. Further interventions decreased the percentage of patients evaluated with both tests to 14.3%. This translates into a decrease in patient charges of approximately $350,000 a year. CONCLUSION: Using simple structured interventions in the ED can reduce amylase ordering. Educational programming alone was not effective in significantly decreasing amylase ordering; however, education plus system-based interventions decreased amylase ordering. Department of Emergency Medicine, University of California, Irvine School of Medicine 2010-09 /pmc/articles/PMC2967686/ /pubmed/21079706 Text en Copyright © 2010 the authors. http://creativecommons.org/licenses/by-nc/4.0 This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Emergency Department Administration
Volz, Kathryn A.
McGillicuddy, Daniel C.
Horowitz, Gary L.
Wolfe, Richard E.
Joyce, Nina
Sanchez, Leon D.
Eliminating Amylase Testing from the Evaluation of Pancreatitis in the Emergency Department
title Eliminating Amylase Testing from the Evaluation of Pancreatitis in the Emergency Department
title_full Eliminating Amylase Testing from the Evaluation of Pancreatitis in the Emergency Department
title_fullStr Eliminating Amylase Testing from the Evaluation of Pancreatitis in the Emergency Department
title_full_unstemmed Eliminating Amylase Testing from the Evaluation of Pancreatitis in the Emergency Department
title_short Eliminating Amylase Testing from the Evaluation of Pancreatitis in the Emergency Department
title_sort eliminating amylase testing from the evaluation of pancreatitis in the emergency department
topic Emergency Department Administration
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2967686/
https://www.ncbi.nlm.nih.gov/pubmed/21079706
work_keys_str_mv AT volzkathryna eliminatingamylasetestingfromtheevaluationofpancreatitisintheemergencydepartment
AT mcgillicuddydanielc eliminatingamylasetestingfromtheevaluationofpancreatitisintheemergencydepartment
AT horowitzgaryl eliminatingamylasetestingfromtheevaluationofpancreatitisintheemergencydepartment
AT wolfericharde eliminatingamylasetestingfromtheevaluationofpancreatitisintheemergencydepartment
AT joycenina eliminatingamylasetestingfromtheevaluationofpancreatitisintheemergencydepartment
AT sanchezleond eliminatingamylasetestingfromtheevaluationofpancreatitisintheemergencydepartment