Effectively reducing amylase testing using computer order entry in the emergency department: quality improvement without eliminating physician choice

Abstract

Background Amylase and lipase, pancreatic biomarkers, are measured in acute pancreatitis diagnosis. Since amylase testing does not add diagnostic value, lipase testing alone is recommended. Despite new recommendations, many physicians and staff continue to test both amylase and lipase. Objective To reduce unnecessary diagnostic testing in acute pancreatitis. Methods The pre-checked amylase test within the Emergency Department's Computerised Provider Order Entry (CPOE) abdominal pain order set was changed to an un-checked state but kept as an option to order with a single click. Amylase testing, lipase testing and cost were measured for one year pre-and post-intervention. Results Simple de-selection intervention reduced redundant amylase testing from 71% to 9%, resulting in a percent of decrease of 87% and an annualised saving of approximately $719,000 in charges. Conclusion CPOE de-selection is an effective tool to reduce non-value added activity and reduce cost while maintaining quality patient care and physician choice.

Superfluous amylase/lipase testing at a tertiary care hospital: a retrospective study

“…However, our finding of a high rate of super-fluous amylase/lipase testing that was mainly due to simultaneous amylase/lipase testing confirms the results of two recent US studies where 71% to 75% of patients had simultaneous amylase/lipase testings. 12,13 The American College of Gastroenterology guidelines and the American Gastroenterology Association technical review state that measuring both serum amylase and lipase in acute pancreatitis is not necessary. 8,9 Consistent with the guidelines, we found that it is rare to have a diagnostic amylase result simultaneously with a non-diagnostic lipase result.…”

“…13 Jaeger and colleges changed the default status of amylase test from checked to un-checked in the order set for abdominal pain; within a year, simultaneous amylase/lipase testing decreased by 87%. 12 Similarly, removing amylase from common order sets in electronic medical records reduced simultaneous amylase/lipase testing by 15% in a US university hospital 15 and decoupling amylase and lipase and removing amylase from order entry forms reduced simultaneous testing from 93% to 14% in a US trauma center. 16 It appears that similar quality-improvement initiatives at KFSHRC could be of benefit.…”

“…11 Nevertheless, the use of both markers appears to still be commonplace. For example, in recent US studies, amylase and lipase were ordered simultaneously in 71% of 10 843 patients 12 and 75% of 13 198 patients. 13…”

Reductions in Medication Wastage and Costs in a Pediatric Intensive Care Unit by Changing the Order Entry System

“…Duplicate orders, unit errors, the use of free text, parameterization flaws, and poor usability of software are probably the root of many prescribing errors [5,6]. The results of a similar study revealed that changing the computerized ordering system could significantly reduce costs [7].…”

In this issue: tools and processes that translate knowledge into practice

“…It is very important to flag how a tiny informatics intervention has an effect. The example in the paper is where a provider wishes to discourage the use of a test called amylase alongside a more specific test called lipase 8. The remit of this journal is to report the impact of the informatics; the issues over which tests to use in pancreatitis are beyond the scope of this journal and remain being discussed in the peer review literature, including a recent Cochrane Review 9…”