Reduction of urea test ordering in the emergency department: multicomponent intervention including education, electronic ordering, and data feedback,Canadian Journal of Emergency Medicine

当前位置： X-MOL 学术 › Can. J. Emerg. Med. › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Reduction of urea test ordering in the emergency department: multicomponent intervention including education, electronic ordering, and data feedback
Canadian Journal of Emergency Medicine ( IF 2.0 ) Pub Date : 2022-07-20 , DOI: 10.1007/s43678-022-00333-w
Pamela Mathura _{1,

2} , Cole Boettger ₁ , Reidar Hagtvedt ₃ , Colleen Sweeney _{2,

4,

5} , Stephen Williams ₆ , Yvonne Suranyi ₂ , Narmin Kassam _{1,

2} , Manpreet Gill _{1,

2,

4}

Affiliation

Introduction

In the emergency department (ED), laboratory testing accounts for a significant portion of the medical assessment. Although excess laboratory test ordering has been proven to be prevalent, different types of interventions have been used to encourage a behavioural change in how physicians order tests. In one western Canadian hospital medicine program, a quality improvement project aimed to reduce the total monthly blood urea nitrogen (BUN) test ordered by physicians was found to be successful. The objective of this project was to evaluate a similar multicomponent intervention aimed at ED physician ordering, with the primary goal of reducing the number of monthly BUN tests ordered per ED visit.

Methods

A pre post intervention design was conducted over 12-months. The first intervention component was an educational presentation conducted by physician leaders. Second, a regularly used order panel within the ED electronic order system was modified, removing the BUN test. The third component involved audit and feedback; the total monthly BUN test ordered for the ED department post intervention start was shared with all ED physicians twice (at 5 and 12 months).An interrupted time series analysis was completed to evaluate the multicomponent intervention effect.

Results

The total monthly ordered BUN test declined from an average of 1905 pre-intervention to 448 post-intervention, and the total monthly BUN test to total ED visit ratio declined from 0.46 to 0.1. These results were a statistically significant reduction in physician BUN test ordering.

Conclusions

Targeted education, order panel design and data feedback interventions can impact physician ordering behaviour in the emergent healthcare context, where diagnostic tests are often over used.

中文翻译：

减少急诊科尿素测试订购：包括教育、电子订购和数据反馈在内的多方面干预

介绍

在急诊科 (ED)，实验室检测占医疗评估的很大一部分。尽管已证明过多的实验室测试订购很普遍，但已使用不同类型的干预措施来鼓励医生订购测试的行为改变。在加拿大西部的一个医院医学项目中，一项旨在减少医生要求的每月血尿素氮 (BUN) 测试总量的质量改进项目被发现是成功的。该项目的目的是评估针对 ED 医生订购的类似多组分干预措施，其主要目标是减少每次 ED 就诊时订购的每月 BUN 测试数量。

方法

在 12 个月内进行了一项前后干预设计。第一个干预部分是由医生领导进行的教育演示。其次，修改了 ED 电子订单系统中常用的订单面板，取消了 BUN 测试。第三部分涉及审计和反馈；ED 部门干预开始后每月订购的总 BUN 测试与所有 ED 医生共享两次（在 5 个月和 12 个月）。完成中断时间序列分析以评估多组分干预效果。