Acute Pancreatitis Alert & Decision Support Improves Care & Cuts Length of Stay

University Of Michigan At Ann Arbor, Ann Arbor MI

Investigators

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Abstract

? DESCRIPTION (provided by applicant): The long-term goal of this research is to develop a portable, scalable software tool to improve treatment for patients with acute pancreatitis (AP). Funds are requested in this R21 proposal to support a 300 patient study using the second generation of The AP Early Response (TAPER)-Clinical Decision Support (CDS)-Tool. The expected outcome is that use of version 2.0 of the TAPER-CDS-Tool will result in increased compliance with accepted clinical guidelines, improved clinical outcome, and lower hospitalization costs for AP patients. AP is the most common reason for gastrointestinal-related hospitalizations. Although accepted clinical guidelines for managing AP exist, compliance with these recommendations is generally poor. Our multidisciplinary quality improvement (QI) team developed the TAPER-CDS-Tool 1.0, which is a combined early automated paging-alert system, which text-pages emergency department (ED) clinicians about a patient with possible AP, and an intuitive, concise web-based point-of-care guide consisting of 7-early management recommendations. In our preliminary study comparing pre and post TAPER-CDS-Tool 1.0 periods involving 223 patients, this Tool associated with increased implementation of 2 of 7-recommendations (fluid resuscitation and risk stratification), and a mean decrease in hospital length-of-stay (LOS) by 2.1 days, associated with savings of $3,874/hospitalization. Although Tool 1.0 significantly improved outcomes and reduced cost of AP, 4 of 7 best practices for AP treatment had poor penetration and only 2 of these 4 improved significantly. Thus, we refined Tool 1.0 to address these shortcomings, and now intend to evaluate the refined TAPER-CDS- Tool 2.0 as the focus of this proposal. The TAPER-CDS-Tool 2.0 is a scalable QI tool intended for widespread use in the ED and during hospitalization to achieve the goals of increased process and quality of care and improved outcomes, specifically shortened hospital LOS. With the expertise of our Information Technology Application Programmer, we focused on integrating Tool 2.0 into the electronic medical record (EMR) as a single source of best practice alerts (BPA) to feed forward key information to users to support real-time clinical decision making at various stages of care: 1) alert notification about the diagnosis of AP, 2) a time-based automated assessment of severity, 3) a time-based automated display of patient specific clinical data showing the response to treatments and 4) an embedded link to the CDS-Tool, containing guideline and institutional recommendations encompassing ED and hospital care. The BPA overcomes limitations of Tool 1.0 by expanding the alert notification to all ED & hospital clinicians, trainees and nurses rather than just ED clinicians and trainees. We anticipate that results from this project will demonstrate an effective, scalable method for implementing clinical guidelines by interfacing with EMR infrastructures, which have been rolled-out for use nationally. Data gathered from this study will be pivotal to design a validating prospective RCT. In the long term, we aim to harness this platform technology and the iterative refinement strategy to develop guideline implementation methods to improve process of care and outcomes for other acute illnesses.