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Am J Gastroenterol 2014; 109:306–315; 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

Matthew J DiMagno MD1,2, Erik-Jan Wamsteker MD1,2, Rafat S Rizk MD1,2, Joshua P Spaete MD1, Suraj Gupta MD1, Tanya Sahay MD1, Jeffrey Costanzo MD1, John M Inadomi MD3,4, Lena M Napolitano MD5, Robert C Hyzy MD6 and Jeff S Desmond MD7

  1. 1Departments of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
  2. 2Division of Gastroenterology and Hepatology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
  3. 3Departments of Internal Medicine, University of Washington School of Medicine, Seattle, Washington, USA
  4. 4Division of Gastroenterology and Hepatology, University of Washington School of Medicine, Seattle, Washington, USA
  5. 5Division of Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
  6. 6Division of Pulmonary and Critical Care, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
  7. 7Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA

Correspondence: Matthew J. DiMagno, MD, Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan School of Medicine, 1150 W. Medical Center Drive, 6520 MSRB 1, Ann Arbor, Michigan 48109, USA. E-mail: mdimagno@umich.edu

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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).

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-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 0–24h (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.