Cargando…

Using the Electronic Medical Record to Reduce Unnecessary Ordering of Coagulation Studies for Patients with Chest Pain

INTRODUCTION: Our goal was to reduce ordering of coagulation studies in the emergency department (ED) that have no added value for patients presenting with chest pain. We hypothesized this could be achieved via implementation of a stopgap measure in the electronic medical record (EMR). METHODS: We u...

Descripción completa

Detalles Bibliográficos
Autores principales: Hinson, Jeremiah S., Mistry, Binoy, Hsieh, Yu-Hsiang, Risko, Nicholas, Scordino, David, Paziana, Karolina, Peterson, Susan, Omron, Rodney
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Department of Emergency Medicine, University of California, Irvine School of Medicine 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5305136/
https://www.ncbi.nlm.nih.gov/pubmed/28210363
http://dx.doi.org/10.5811/westjem.2016.12.31927
_version_ 1782507003548008448
author Hinson, Jeremiah S.
Mistry, Binoy
Hsieh, Yu-Hsiang
Risko, Nicholas
Scordino, David
Paziana, Karolina
Peterson, Susan
Omron, Rodney
author_facet Hinson, Jeremiah S.
Mistry, Binoy
Hsieh, Yu-Hsiang
Risko, Nicholas
Scordino, David
Paziana, Karolina
Peterson, Susan
Omron, Rodney
author_sort Hinson, Jeremiah S.
collection PubMed
description INTRODUCTION: Our goal was to reduce ordering of coagulation studies in the emergency department (ED) that have no added value for patients presenting with chest pain. We hypothesized this could be achieved via implementation of a stopgap measure in the electronic medical record (EMR). METHODS: We used a pre and post quasi-experimental study design to evaluate the impact of an EMR-based intervention on coagulation study ordering for patients with chest pain. A simple interactive prompt was incorporated into the EMR of our ED that required clinicians to indicate whether patients were on anticoagulation therapy prior to completion of orders for coagulation studies. Coagulation order frequency was measured via detailed review of randomly sampled encounters during two-month periods before and after intervention. We classified existing orders as clinically indicated or non-value added. Order frequencies were calculated as percentages, and we assessed differences between groups by chi-square analysis. RESULTS: Pre-intervention, 73.8% (76/103) of patients with chest pain had coagulation studies ordered, of which 67.1% (51/76) were non-value added. Post-intervention, 38.5% (40/104) of patients with chest pain had coagulation studies ordered, of which 60% (24/40) were non-value added. There was an absolute reduction of 35.3% (95% confidence interval [CI]: 22.7%, 48.0%) in the total ordering of coagulation studies and 26.4% (95% CI: 13.8%, 39.0%) in non-value added order placement. CONCLUSION: Simple EMR-based interactive prompts can serve as effective deterrents to indiscriminate ordering of diagnostic studies.
format Online
Article
Text
id pubmed-5305136
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher Department of Emergency Medicine, University of California, Irvine School of Medicine
record_format MEDLINE/PubMed
spelling pubmed-53051362017-02-16 Using the Electronic Medical Record to Reduce Unnecessary Ordering of Coagulation Studies for Patients with Chest Pain Hinson, Jeremiah S. Mistry, Binoy Hsieh, Yu-Hsiang Risko, Nicholas Scordino, David Paziana, Karolina Peterson, Susan Omron, Rodney West J Emerg Med Technology in Emergency Medicine INTRODUCTION: Our goal was to reduce ordering of coagulation studies in the emergency department (ED) that have no added value for patients presenting with chest pain. We hypothesized this could be achieved via implementation of a stopgap measure in the electronic medical record (EMR). METHODS: We used a pre and post quasi-experimental study design to evaluate the impact of an EMR-based intervention on coagulation study ordering for patients with chest pain. A simple interactive prompt was incorporated into the EMR of our ED that required clinicians to indicate whether patients were on anticoagulation therapy prior to completion of orders for coagulation studies. Coagulation order frequency was measured via detailed review of randomly sampled encounters during two-month periods before and after intervention. We classified existing orders as clinically indicated or non-value added. Order frequencies were calculated as percentages, and we assessed differences between groups by chi-square analysis. RESULTS: Pre-intervention, 73.8% (76/103) of patients with chest pain had coagulation studies ordered, of which 67.1% (51/76) were non-value added. Post-intervention, 38.5% (40/104) of patients with chest pain had coagulation studies ordered, of which 60% (24/40) were non-value added. There was an absolute reduction of 35.3% (95% confidence interval [CI]: 22.7%, 48.0%) in the total ordering of coagulation studies and 26.4% (95% CI: 13.8%, 39.0%) in non-value added order placement. CONCLUSION: Simple EMR-based interactive prompts can serve as effective deterrents to indiscriminate ordering of diagnostic studies. Department of Emergency Medicine, University of California, Irvine School of Medicine 2017-02 2017-01-30 /pmc/articles/PMC5305136/ /pubmed/28210363 http://dx.doi.org/10.5811/westjem.2016.12.31927 Text en Copyright: © 2017 Hinson et al. http://creativecommons.org/licenses/by/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/4.0/
spellingShingle Technology in Emergency Medicine
Hinson, Jeremiah S.
Mistry, Binoy
Hsieh, Yu-Hsiang
Risko, Nicholas
Scordino, David
Paziana, Karolina
Peterson, Susan
Omron, Rodney
Using the Electronic Medical Record to Reduce Unnecessary Ordering of Coagulation Studies for Patients with Chest Pain
title Using the Electronic Medical Record to Reduce Unnecessary Ordering of Coagulation Studies for Patients with Chest Pain
title_full Using the Electronic Medical Record to Reduce Unnecessary Ordering of Coagulation Studies for Patients with Chest Pain
title_fullStr Using the Electronic Medical Record to Reduce Unnecessary Ordering of Coagulation Studies for Patients with Chest Pain
title_full_unstemmed Using the Electronic Medical Record to Reduce Unnecessary Ordering of Coagulation Studies for Patients with Chest Pain
title_short Using the Electronic Medical Record to Reduce Unnecessary Ordering of Coagulation Studies for Patients with Chest Pain
title_sort using the electronic medical record to reduce unnecessary ordering of coagulation studies for patients with chest pain
topic Technology in Emergency Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5305136/
https://www.ncbi.nlm.nih.gov/pubmed/28210363
http://dx.doi.org/10.5811/westjem.2016.12.31927
work_keys_str_mv AT hinsonjeremiahs usingtheelectronicmedicalrecordtoreduceunnecessaryorderingofcoagulationstudiesforpatientswithchestpain
AT mistrybinoy usingtheelectronicmedicalrecordtoreduceunnecessaryorderingofcoagulationstudiesforpatientswithchestpain
AT hsiehyuhsiang usingtheelectronicmedicalrecordtoreduceunnecessaryorderingofcoagulationstudiesforpatientswithchestpain
AT riskonicholas usingtheelectronicmedicalrecordtoreduceunnecessaryorderingofcoagulationstudiesforpatientswithchestpain
AT scordinodavid usingtheelectronicmedicalrecordtoreduceunnecessaryorderingofcoagulationstudiesforpatientswithchestpain
AT pazianakarolina usingtheelectronicmedicalrecordtoreduceunnecessaryorderingofcoagulationstudiesforpatientswithchestpain
AT petersonsusan usingtheelectronicmedicalrecordtoreduceunnecessaryorderingofcoagulationstudiesforpatientswithchestpain
AT omronrodney usingtheelectronicmedicalrecordtoreduceunnecessaryorderingofcoagulationstudiesforpatientswithchestpain