在急诊科通过计算机医嘱录入有效减少淀粉酶检测：在不消除医生选择权的情况下提高质量。
Effectively reducing amylase testing using computer order entry in the emergency department: quality improvement without eliminating physician choice.
作者信息
Jaeger Cassie, Sullivan Paul, Waymack James, Griffen David Griffen
机构信息
Southern Illinois University, School of Medicine, Center for Clinical Research, Springfield.
CLSSBB Laboratory Quality & Safety, Memorial Medical Center, Springfield.
出版信息
J Innov Health Inform. 2017 Oct 6;24(3):907. doi: 10.14236/jhi.v24i3.907.
BACKGROUND
Amylase and lipase, pancreatic biomarkers, are measured in acute pancreatitis diagnosis. Since amylase testing does not add diagnostic value, lipase testing alone is recommended. Despite new recommendations, many physicians and staff continue to test both amylase and lipase.
OBJECTIVE
To reduce unnecessary diagnostic testing in acute pancreatitis.
METHODS
The pre-checked amylase test within the Emergency Department's Computerized Provider Order Entry (CPOE) abdominal pain order set was changed to an un-checked state, but kept as an option to order with a single click. Amylase testing, lipase testing and cost were measured for one year pre and post intervention.
RESULTS
Simple de-selection intervention reduced redundant amylase testing from 71% to 9%, resulting in a percent of decrease of 87% and an annualized saving of approximately $719,000 in charges.
CONCLUSION
CPOE de-selection is an effective tool to reduce non-value added activity and reduce cost while maintaining quality patient care and physician choice.
背景
淀粉酶和脂肪酶作为胰腺生物标志物，用于急性胰腺炎的诊断。由于淀粉酶检测不增加诊断价值，因此建议仅进行脂肪酶检测。尽管有新的建议，但许多医生和工作人员仍继续同时检测淀粉酶和脂肪酶。
目的
减少急性胰腺炎中不必要的诊断检测。
方法
将急诊科计算机医嘱录入系统（CPOE）腹痛医嘱集中预先勾选的淀粉酶检测改为未勾选状态，但仍保留一键下单的选项。在干预前后各一年时间内，对淀粉酶检测、脂肪酶检测及成本进行了测量。
结果
简单的取消勾选干预措施将冗余淀粉酶检测从71%降至9%，降幅达87%，每年节省费用约71.9万美元。
结论
CPOE取消勾选是一种有效的工具，可减少无附加价值的活动并降低成本，同时维持优质的患者护理和医生的选择权。
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