A combined paging alert and web-based instrument alters clinician behavior and shortens hospital length of stay in acute pancreatitis.

Autor:	Dimagno MJ; 1] Departments of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA [2] Division of Gastroenterology and Hepatology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA., Wamsteker EJ; 1] Departments of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA [2] Division of Gastroenterology and Hepatology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA., Rizk RS; 1] Departments of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA [2] Division of Gastroenterology and Hepatology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA., Spaete JP; Departments of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA., Gupta S; Departments of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA., Sahay T; Departments of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA., Costanzo J; Departments of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA., Inadomi JM; 1] Departments of Internal Medicine, University of Washington School of Medicine, Seattle, Washington, USA [2] Division of Gastroenterology and Hepatology, University of Washington School of Medicine, Seattle, Washington, USA., Napolitano LM; Division of Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan, USA., Hyzy RC; Division of Pulmonary and Critical Care, University of Michigan School of Medicine, Ann Arbor, Michigan, USA., Desmond JS; Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA.
Jazyk:	angličtina
Zdroj:	The American journal of gastroenterology [Am J Gastroenterol] 2014 Mar; Vol. 109 (3), pp. 306-15.
DOI:	10.1038/ajg.2013.282
Abstrakt:	Objectives: There are many published clinical guidelines for acute pancreatitis (AP). Implementation of these recommendations is variable. We hypothesized that a clinical decision support (CDS) tool would change clinician behavior and shorten hospital length of stay (LOS). Design/setting: Observational study, entitled, The AP Early Response (TAPER) Project. Tertiary center emergency department (ED) and hospital. Participants: Two consecutive samplings of patients having ICD-9 code (577.0) for AP were generated from the emergency department (ED) or hospital admissions. Diagnosis of AP was based on conventional Atlanta criteria. The Pre-TAPER-CDS-Tool group (5/30/06-6/22/07) had 110 patients presenting to the ED with AP per 976 ICD-9 (577.0) codes and the Post-TAPER-CDS-Tool group (5/30/06-6/22/07) had 113 per 907 ICD-9 codes (7/14/10-5/5/11). Intervention: The TAPER-CDS-Tool, developed 12/2008-7/14/2010, is a combined early, automated paging-alert system, which text pages ED clinicians about a patient with AP and an intuitive web-based point-of-care instrument, consisting of seven early management recommendations. Results: The pre- vs. post-TAPER-CDS-Tool groups had similar baseline characteristics. The post-TAPER-CDS-Tool group met two management goals more frequently than the pre-TAPER-CDS-Tool group: risk stratification (P<0.0001) and intravenous fluids >6L/1st 0-24 h (P=0.0003). Mean (s.d.) hospital LOS was significantly shorter in the post-TAPER-CDS-Tool group (4.6 (3.1) vs. 6.7 (7.0) days, P=0.0126). Multivariate analysis identified four independent variables for hospital LOS: the TAPER-CDS-Tool associated with shorter LOS (P=0.0049) and three variables associated with longer LOS: Japanese severity score (P=0.0361), persistent organ failure (P=0.0088), and local pancreatic complications (<0.0001). Conclusions: The TAPER-CDS-Tool is associated with changed clinician behavior and shortened hospital LOS, which has significant financial implications.
Databáze:	MEDLINE
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