A Combined Paging Alert and Web-Based Instrument Alters Clinician Behavior and Shortens Hospital Length of Stay in Acute Pancreatitis

作者：DiMagno Matthew J^*; Wamsteker Erik Jan; Rizk Rafat S; Spaete Joshua P; Gupta Suraj; Sahay Tanya; Costanzo Jeffrey; Inadomi John M; Napolitano Lena M; Hyzy Robert C; Desmond Jeff S

来源：American Journal of Gastroenterology, 2014, 109(3): 306-315.

DOI：10.1038/ajg.2013.282

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).
METHODS: 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-CDSTool group met two management goals more frequently than the pre-TAPER-CDS-Tool group: risk stratifi cation (P<0.0001) and intravenous fluids > 6L/1st 0-24h (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.

• 出版日期2014-3