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Observational Study
. 2014 Mar;109(3):306-15.
doi: 10.1038/ajg.2013.282.

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

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Free PMC article
Observational Study

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

Matthew J Dimagno et al. Am J Gastroenterol. .
Free PMC article

Abstract

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.

Conflict of interest statement

CONFLICT OF INTEREST

Guarantor of the article: Matthew J. DiMagno, MD.

Author Contributions: Study concept and design (M.J.D.), design of the TAPER-CDS-Tool (M.J.D., E.J.W., R.S.R., L.M.N., R.C.H., J.S.D.), acquisition of data (J.P.S., S.G., T.S., J.C., M.J.D., E.J.W.), analysis and interpretation of data (M.J.D., E.J.W., J.M.I., J.P.S., S.G., T.S., R.S.R., L.M.N., R.C.H., J.S.D.), drafting of the manuscript (M.J.D.), critical revision of the manuscript for important intellectual content (M.J.D., E.J.W., J.M.I., J.P.S., S.G., T.S., R.S.R., L.M.N., R.C.H., J.S.D.), statistical analysis (M.J.D., J.M.I.) and study supervision (M.J.D.).

Financial support: K24 DK080941 (JMI) and K08 DK073298 (MJD)

Potential competing interests: All authors disclose no conflict of interest. M.J.D received honoraria from the British Medical Journal (BMJ) Publishing Group Limited for articles published in BMJ Point-of-Care.

Figures

Figure 1
Figure 1
Methodological summary.
Figure 2
Figure 2
The “TAPER-CDS-Tool”, which has two components: The AP Early Response (TAPER) automated paging alert system and an intuitive web-based point-of-care clinical decision support (CDS) instrument (PancMap). Reprinted from DiMagno et al. (53) (Copyright 2010, with permission from the Regents of the University of Michigan).

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