Troponin testing in the emergency department: a longitudinal study to assess the impact and sustainability of decision support strategies
- 1Centre for Health Systems and Safety Research, University of New South Wales, Sydney, New South Wales, Australia
- 2Faculty of Health Science, The University of Sydney, Lidcombe, New South Wales, Australia
- 3Pathology IT, Austin Health, Heidelberg, Victoria, Australia
- 4Austin Centre for Applied Clinical Informatics, Austin Hospital, Heidelberg, Victoria, Australia
- 5Department of Intensive Care, Austin Hospital, Heidelberg, Victoria, Australia
- Correspondence to Dr Andrew Georgiou, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW 2052, Australia;
Contributors AG, GKH, JA and JIW were all involved in the conception and design of the study. AG and ML were involved in the initial analysis of the data and drafting of the paper. All authors played a role in aspects of the analysis and interpretation of the data, critical revision of the paper for important intellectual content and its final approval before submission.
- Accepted 4 February 2012
- Published Online First 12 March 2012
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 periods—pre (2000–2), post (2003–4) and post-modification (2005–7)—from 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.
- Chemical pathology
- clinical decision support systems
- computer assisted
- computer systems
- emergency medicine
- evidence-based pathology
- forensic pathology
- health services res
- information technology
- laboratory tests
- medical informatics
Funding This research was supported by an Australian Department of Health and Ageing, quality use of pathology programme grant (2007–9).
Competing interests None.
Ethics approval This study was approved by Austin Hospital Human Research Ethics Committee, Victoria.
Provenance and peer review Not commissioned; externally peer reviewed.