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【文献翻译】Implementation of Clinical Decision Support Rules to Reduce...

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发表于 2016-6-2 15:04:38 | 显示全部楼层 |阅读模式
Implementation of Clinical Decision Support Rules to Reduce Repeat Measurement of Serum Ionized Calcium, Serum Magnesium, and N-Terminal Pro-B-Type Natriuretic Peptide in Intensive Care Unit Inpatients

BACKGROUND: We assessed the impact of clinical decision support (CDS) rules within the electronic health record for ionized calcium (iCa), serum magnesium (Mg), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in intensive care unit (ICU) inpatients at a large academic center.

METHODS: A repeat order for measurement of iCa or Mg placed within 24 (iCa) or 48 (Mg) h of a previously nonactionable result, or additional orders for NT-proBNP beyond 1 within a single hospitalization, triggered a CDS pop-up alert showing the prior result and offering the opportunity to cancel the order or to place the order after entering an indication for repeat testing. The number of tests performed for each of these analytes and incidence of adverse clinical outcomes potentially associated with hypocalcemia or hypomagnesemia were compared between the 90-day period before CDS implementation and two 90-day periods immediately following.

RESULTS: iCa test volumes decreased by 48%, Mg by 39%, and NT-proBNP by 28% in the 90-day period immediately following implementation and remained decreased by 54%, 49%, and 22%, respectively, during the following 90-day period (all P values <0.0002). Adverse clinical outcomes potentially associated with hypocalcemia or hypomagnesemia did not increase (all P-values >0.17).

CONCLUSIONS: Implementation of CDS dramatically decreased repeat testing of iCa, Mg, and NT-proBNP without adversely impacting clinical outcomes in the ICU. Expansion of the rules from the ICU units to include the entire hospitalized patient population and expansion to additional analytes is expected to lead to further reductions in testing.

链接:http://www.clinchem.org/content/62/6/824.abstract

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发表于 2016-6-3 14:30:27 | 显示全部楼层
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发表于 2016-6-5 22:37:09 | 显示全部楼层
实施临床决策支持规则以减少重症监护室住院患者对于血清离子钙、血清镁和N末端B型利钠肽原的重复检测

背景:我们根据大型医学中心的重症监护室(ICU)住院患者的血清离子钙(iCa)、血清镁(Mg)和N末端B型利钠肽原(NT-proBNP)的电子健康记录,评估其临床决策支持(CDS)规则的影响。

方法:在24小时(iCa)和48小时(Mg)内,对于之前不可操作的结果重复进行iCa和Mg测试的要求,或者对于在一次住院治疗中超过一次的NT-proBNP额外测试要求,引发CDS弹出警报,显示之前的结果并提供取消该要求的机会或在输入重复检测的指示之后实施该要求。比较实施CDS之前的90天与随后的两个为期90天的期间内每一种分析物实施试验次数以及与低钙血症或低镁血症潜在相关的不良临床预后的发生率。

结果:在以90天为期的即时后续实施中,iCA检测量下降48%,镁检测量下降39%,NT-proBNP检测量下降28%,并且在接下来的90天期间里分别继续下降了54%、49%和22%(所有P值均小于0.0002)。与低钙血症和低镁血症相关的潜在的不良临床预后没有增加(所有P值均大于0.17)。

结论:CDS的实施显著降低了iCA、Mg和NT-proBNP的重复测试,且对于ICU的临床结果没有不利影响。将此规则从ICU病房扩展到包括整个住院患者人口并扩展到额外的分析物预计将导致测试的进一步减少。

链接:http://www.clinchem.org/content/62/6/824.abstract
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