scholarly journals Effectively reducing amylase testing using computer order entry in the emergency department: quality improvement without eliminating physician choice

2017 ◽  
Vol 24 (3) ◽  
pp. 257 ◽  
Author(s):  
Cassie Jaeger ◽  
Paul Sullivan ◽  
James Waymack ◽  
David Griffen Griffen
Keyword(s):  
Emergency Department ◽  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Diagnostic Testing ◽  
Value Added ◽  
Diagnostic Value ◽  
Order Entry ◽  
Computerized Provider Order Entry ◽  
Quality Patient Care ◽  
One Year

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.

scholarly journals Polyclonal pancreatic elastase assay is superior to monoclonal assay for diagnosis of acute pancreatitis

1997 ◽  
Vol 43 (12) ◽  
pp. 2339-2344 ◽  
Author(s):  
Volker Keim ◽  
Niels Teich ◽  
Andrea Reich ◽  
Fritz Fiedler ◽  
Joachim Mössner
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Polyclonal Antibodies ◽  
Roc Curves ◽  
Diagnostic Value ◽  
Serum Concentrations ◽  
Clinical Value ◽  
Serum Samples ◽  
Pancreatic Elastase ◽  
Serum Elisa

Abstract We compared the clinical values for diagnosis of acute pancreatitis of two commercial assays for pancreatic elastase: an ELISA procedure with monoclonal antibodies and a RIA technique with polyclonal antibodies. In 14 patients with acute pancreatitis, serum concentrations of elastase determined by ELISA (ELISA-elastase) decreased much faster (half-life 0.4 days) than those of elastase determined by RIA (RIA-elastase) (2.2 days), amylase (0.8 days), or lipase (0.9 days). Serum samples from 253 additional patients with abdominal pain (32 of these with acute pancreatitis) were analyzed. In sera collected up to 48 h after the onset of disease, the ROC curves showed a slightly higher diagnostic value of RIA-elastase. In samples taken later, at a sensitivity of 90% the specificity of RIA-elastase was 95% (ELISA-elastase 40%). We conclude that serum ELISA-elastase is of much lower clinical value than RIA-elastase for diagnosis of acute pancreatitis.

scholarly journals The impact of computerized provider order entry on emergency department flow

CJEM ◽  
2016 ◽  
Vol 18 (4) ◽  
pp. 264-269 ◽  
Author(s):  
Andrew Gray ◽  
Christopher M.B. Fernandes ◽  
Kristine Van Aarsen ◽  
Melanie Columbus
Keyword(s):  
Emergency Department ◽  
Patient Safety ◽  
Improve Patient Safety ◽  
Patient Flow ◽  
Wait Time ◽  
Order Entry ◽  
Computerized Provider Order Entry ◽  
Left Without Being Seen ◽  
Before And After ◽  
The Impact

AbstractObjectivesComputerized provider order entry (CPOE) has been established as a method to improve patient safety by avoiding medication errors; however, its effect on emergency department (ED) flow remains undefined. We examined the impact of CPOE implementation on three measures of ED throughput: wait time (WT), length of stay (LOS), and the proportion of patients that left without being seen (LWBS).MethodsWe conducted a retrospective cohort study of all ED patients of 18 years and older presenting to London Health Sciences Centre during July and August 2013 and 2014, before and after implementation of a CPOE system. The three primary variables were compared between time periods. Subgroup analyses were also conducted within each Canadian Triage and Acuity Scale (CTAS) level (1–5) individually, as well as for admitted patients only.ResultsA significant increase in WT of 5 minutes (p=0.036) and LOS of 10 minutes (p=0.001), and an increase in LWBS from 7.2% to 8.1% (p=0.002) was seen after CPOE implementation. Admitted patients’ LOS increased by 63 minutes (p<0.001), the WT of CTAS 3 and 5 patients increased by 6 minutes (p=0.001) and 39 minutes (p=0.005), and LWBS proportion increased significantly for CTAS 3–5 patients, from 24.3% to 42.0% (p<0.001) for CTAS 5 patients specifically.ConclusionsCPOE implementation detrimentally impacted all patient flow throughput measures that we examined. The most striking clinically relevant result was the increase in LOS of 63 minutes for admitted patients. This raises the question as to whether the potential detrimental effects to patient safety of CPOE implementation outweigh its benefits.

scholarly journals Ileocecal Fistula Caused by Multiple Foreign Magnetic Bodies Ingestion

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Vittorio Cherchi ◽  
Gian Luigi Adani ◽  
Elda Righi ◽  
Umberto Baccarani ◽  
Giovanni Terrosu ◽  
...  
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Foreign Body ◽  
Clinical Condition ◽  
Correct Diagnosis ◽  
Intestinal Wall ◽  
Accidental Ingestion ◽  
The Us ◽  
Manual Suture ◽  
One Year

The incidence of accidental foreign body (FBs) ingestion is 100,000 cases/year in the US, with over than 80% of cases occurring in children below 5 years of age. Although a single FB may pass spontaneously and uneventfully through the digestive tract, the ingestion of multiple magnetics can cause serious morbidity due to proximate attraction through the intestinal wall. Morbidity and mortality depend on a prompt and correct diagnosis which is often difficult and delayed due to the patient's age and because the accidental ingestion may go unnoticed. We report our experience in the treatment of an 11-year-old child who presented to the emergency department with increasing abdominal pain, vomiting, diarrhea, and fever. Surgery evidenced an ileocecal fistula secondary to multiple magnetic FB ingestion with attraction by both sides of the intestinal wall. A 5-centimeter ileal resection was performed, and the cecal fistula was closed with a longitudinal manual suture. The child was discharged at postoperative day 8. After one year, the patient’s clinical condition was good.

scholarly journals Abruptio Placentae Caused by Hypertriglyceridemia-Induced Acute Pancreatitis during Pregnancy: Case Report and Literature Review

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
Pınar Yalcin Bahat ◽  
Gokce Turan ◽  
Berna Aslan Cetin
Keyword(s):  
Emergency Department ◽  
Acute Pancreatitis ◽  
Risk Factor ◽  
Abdominal Pain ◽  
Literature Review ◽  
Epigastric Pain ◽  
Serum Insulin ◽  
High Rate ◽  
Abruptio Placentae ◽  
Uterine Contractions

Background. Hormonal effects during pregnancy can compromise otherwise controlled lipid levels in women with hypertriglyceridemia and predispose to pancreatitis leading to increased morbidity for mother and fetus. Elevation of triglyceride levels is a risk factor for development of pancreatitis if it exceeds 1000 mg/dL. Pancreatitis should be considered in emergency cases of abdominal pain and uterine contractions in Emergency Department at any stage of pregnancy. We report a case of abruptio placentae caused by hypertriglyceridemia-induced acute pancreatitis. Also, literature review of cases of acute pancreatitis induced by hypertriglycaemia in pregnancy has been made. Case. A 22-year-old woman presented to our Emergency Department, at 35 weeks of gestation, for acute onset of abdominal pain and uterine contractions. Blood tests showed a high rate of triglyceride. The patient was diagnosed with abruptio placentae caused by hypertriglyceridemia-induced acute pancreatitis. Immediate cesarean section was performed and it was observed that blood sample revealed a milky turbid serum. Insulin, heparin, and supportive treatment were started. She was discharged on the 10th day. Conclusion. Consequently, patients with known hypertriglyceridemia or family history should be followed up more closely because any delay can cause disastrous conclusions for mother and fetus. Acute pancreatitis should be considered in pregnant women who have sudden onset, severe, persistent epigastric pain and who have a risk factor for acute pancreatitis.

Computerized provider order entry improves compliance of vancomycin dosing guidelines in the emergency department

2013 ◽  
Vol 31 (12) ◽  
pp. 1715-1716 ◽  
Author(s):  
Kathryn C. Frankel ◽  
Jamie M. Rosini ◽  
Brian J. Levine ◽  
Mia A. Papas ◽  
Neil B. Jasani
Keyword(s):  
Emergency Department ◽  
Order Entry ◽  
Computerized Provider Order Entry

scholarly journals Routine Measurement of Serum Amylase in Acute Abdomen

2014 ◽  
Vol 52 (196) ◽  
pp. 982-985 ◽  
Author(s):  
Roshan Ghimire ◽  
Anurag Singh Thapa ◽  
Dimindra Karki ◽  
Dipendra Kumar Shrestha
Keyword(s):  
Emergency Department ◽  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Acute Abdomen ◽  
Serum Amylase ◽  
Acute Abdominal Pain ◽  
College Teaching ◽  
Amylase Level ◽  
Serum Amylase Level ◽  
Routine Measurement

Introduction: Acute abdominal pain is a common condition presenting to both the emergency department and surgical admission unit. Increase in serum amylase levels are found in much gastrointestinal pathology. Serum amylase level is consistently high in acute pancreatitis though high values are not pathognomonic of pancreatitis .The aim of this study to assess the level of serum amylase in various diseases presenting with acute abdominal pain and to evaluate the role of routine measurement of serum amylase in the screening of patient with acute abdominal pain for the diagnosis of acute pancreatitis in a prospective series. Methods: A prospective observational study was performed from 15th May 2014 – 15th Nov 2014 (6 months) at Department of Surgery of Kathmandu medical College Teaching Hospital; Kathmandu. All consecutive patients presented at emergency department and required admissions in surgical ward were included. A multivariate analysis was performed to assess the level of serum amylase in various diseases presenting with acute abdominal pain including acute pancreatitis. Results: Overall, 318 patients were included during a period of 6 months among them 48 patients were excluded. 34 cases (12.6 %) were diagnosed of acute pancreatitis. three cases (1.1%) of non pancreatic pathology with raised serum amylase level (> 1000 U\L). Conclusions: Routine assessment of serum amylase is helpful in excluding differential diagnosis of patient presenting with acute abdomen and this study identified serum amylase as a good screening tool if done in cases with clinical suspicion.  Keywords: acute abdominal pain; acute pancreatitis; serum amylase.

scholarly journals Impact of Clinical Experience and Diagnostic Performance in Patients with Acute Abdominal Pain

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Helena Laurell ◽  
Lars-Erik Hansson ◽  
Ulf Gunnarsson
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Diagnostic Performance ◽  
Acute Abdominal Pain ◽  
Final Diagnosis ◽  
Emergency Department Physician ◽  
Time Of Arrival ◽  
Base Line ◽  
Preliminary Diagnosis ◽  
One Year

Background.The aims were to evaluate the importance of the formal competence of the emergency department physician, the patient’s time of arrival at the emergency department, and the use of a structured schedule for investigation of patients with acute abdominal pain.Methods.Patients attending the Mora Hospital with acute abdominal pain from 1997 to 2000 were registered prospectively according to a structured schedule. Registration included history, symptoms, signs, preliminary diagnosis, surgery and final diagnosis after at least one year.  Results.3073 acute abdominal pain patients were included. The preliminary diagnosis, as compared with the final diagnosis, was correct in 54%(n=1659). Previously, during 1996, a base-line registration of 790 patients had a 58% correct diagnoses  (n=458). A majority of the patients (n=2699; 88%) were managed by nonspecialists. The proportion of correct diagnoses was 54%(n=759)for pre-registrar house officers and 55%(n=443)for senior house officers. Diagnostic performance at the emergency department was independent of patient’s time of arrival.Conclusions.A structured schedule for investigation did not improve the diagnostic precision at the emergency department in patients with acute abdominal pain. The diagnostic performance was independent of the formal competence of the physician and the patient's time of arrival.

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