Abstract
We designed and implemented 2 automated, computerized screens for use at the time of antiepileptic drug (AED) test order entry to improve appropriateness by reminding physicians when a potentially redundant test was ordered and providing common indications for monitoring and pharmacokinetics of the specific AED. All computerized orders for inpatient serum AED levels during two 3-month periods were included in the study. During the 3-month period after implementation of the automated intervention, 13% of all AED tests ordered were canceled following computerized reminders. For orders appearing redundant, the cancellation rate was 27%. For nonredundant orders, 4% were canceled when information on specific AED monitoring and pharmacokinetics was provided. The cancellation rate was sustained after 4 years. There has been a 19.5% decrease in total AED testing volume since implementation of this intervention, despite a 19.3% increase in overall chemistry test volume. Inappropriateness owing to repeated testing before pharmacologic steady state was reached decreased from 54% of all AED orders to 14.6%. A simple, automated, activity-based intervention targeting a specific testordering behavior effectively reduced inappropriate laboratory testing. The sustained benefit supports the idea that computerized interventions may durably affect physician behavior. Computerized delivery of such evidence-based boundary guidelines can help narrow the gap between evidence and practice.
Original language | English (US) |
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Pages (from-to) | 432-438 |
Number of pages | 7 |
Journal | American journal of clinical pathology |
Volume | 119 |
Issue number | 3 |
DOIs | |
State | Published - Mar 1 2003 |
Keywords
- Antiepileptic drug level
- Appropriateness
- Benchmark
- Evidence-based medicine
- Guidelines
- Indicators
- Test ordering
- Utilization
ASJC Scopus subject areas
- Pathology and Forensic Medicine