Troponin testing in the emergency department: a longitudinal study to assess the impact and sustainability of decision support strategies. Issue 6 (12th March 2012)

• Record Type: Journal Article
• Authors: Georgiou, Andrew; Lam, Mary; Allardice, Jane; Hart, Graeme K; Westbrook, Johanna I
• Is Part Of: Journal of clinical pathology. Volume 65:Issue 6(2012)
• Page Start: 546
• Page End: 550
• Publication Date: 2012-03-12
• Subjects: Chemical pathology -- clinical decision support systems -- computer assisted -- computer systems -- emergency medicine -- evidence-based pathology -- forensic pathology -- health services res -- information technology -- laboratory tests -- medical informatics -- pathology -- troponin; Pathology -- Periodicals; Pathology, Molecular -- Periodicals; 616.0705
• DOI: 10.1136/jclinpath-2011-200610
• Languages: English
• ISSNs: 0021-9746

Abstract

Abstract : Aim: To evaluate the impact of decision support on the proportion of troponin I (cTnI) tests and associated costs over the period 2000–7 for patients presenting with chest pain in an emergency department (ED) setting. Methods: A longitudinal study using linked data for patients presenting with chest pain from the ED and laboratory information systems of a metropolitan teaching hospital in Melbourne, Australia. The study period was divided into a pre-intervention period (2000–2), which contained no decision support; an initial post period (2003–4) after the introduction of a quality improvement initiative (utilising a paper-based guideline, education, audit and feedback) about cTnI test ordering and the incorporation of the guideline as a decision support feature of the computerised provider order entry system; followed by a post-modification period (2005–7) after the electronic decision support feature was modified to allow clinicians to bypass viewing the complete guideline. Results: There was a significant fall in the proportion of cTnI tests ordered per patient presentation across the three periods—pre (2000–2), post (2003–4) and post-modification (2005–7)—from 7.3% to 4.1% and 2.8%, respectively. Analysis of costs showed significant reductions in the mean costs for cTnI tests per patient presentation from $A9.28 to $A8.54 and $A8.18, respectively, which amounted to a modest saving of $A13 251 since the initiation of decision support in 2003. Conclusions: Decision support systems are often part of multifaceted implementations undertaken over time. They require continuous monitoring and modifications to ensure optimal performance.