Troponin testing in the emergency department: A longitudinal study to assess the impact and sustainability of decision support strategies

  • Georgiou A
  • Lam M
  • Allardice J
 et al. 
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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 periodsdpre (2000-2), post (2003-4) and postmodification (2005-7)dfrom 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.

Author-supplied keywords

  • *emergency health service
  • *protein analysis
  • *troponin I/ec [Endogenous Compound]
  • *troponin/ec [Endogenous Compound]
  • Australia
  • Chemical pathology
  • article
  • clinical decision support systems
  • computer assisted
  • computer systems
  • decision support system
  • emergency medicine
  • emergency ward
  • evidence-based pathology
  • forensic pathology
  • health care cost
  • health services res
  • human
  • information technology
  • laboratory test
  • laboratory tests
  • longitudinal study
  • major clinical study
  • medical decision making
  • medical informatics
  • pathology
  • practice guideline
  • priority journal
  • thorax pain
  • troponin

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Authors

  • Andrew Georgiou

  • Mary Lam

  • Jane Allardice

  • Graeme Hart

  • Johanna Westbrook

  • Georgiou A.

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