Implementation of clinical decision support rules to reduce repeat measurement of serum ionized calcium, serum magnesium, and N-terminal pro-B-type natriuretic peptide in intensive care unit inpatients

Ann M. Moyer, Amy K. Saenger, Maria Willrich, Leslie J. Donato, Nikola A. Baumann, Darci R. Block, Chad M. Botz, Munawwar A. Khan, Allan S. Jaffe, Curtis A. Hanson, Brad S. Karon

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

BACKGROUND: We assessed the impact of clinical decision support (CDS) rules within the electronic health record for ionized calcium (iCa), serum magnesium (Mg), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in intensive care unit (ICU) inpatients at a large academic center. METHODS: A repeat order for measurement of iCa or Mg placed within 24 (iCa) or 48 (Mg) h of a previously nonactionable result, or additional orders for NT-proBNP beyond 1 within a single hospitalization, triggered a CDS pop-up alert showing the prior result and offering the opportunity to cancel the order or to place the order after entering an indication for repeat testing. The number of tests performed for each of these analytes and incidence of adverse clinical outcomes potentially associated with hypocalcemia or hypomagnesemia were compared between the 90-day period before CDS implementation and two 90-day periods immediately following. RESULTS: iCa test volumes decreased by 48%, Mg by 39%, and NT-proBNP by 28% in the 90-day period immediately following implementation and remained decreased by 54%, 49%, and 22%, respectively, during the following 90-day period (all P values 0.17). CONCLUSIONS: Implementation of CDS dramatically decreased repeat testing of iCa, Mg, and NT-proBNP without adversely impacting clinical outcomes in the ICU. Expansion of the rules from the ICU units to include the entire hospitalized patient population and expansion to additional analytes is expected to lead to further reductions in testing.

Original languageEnglish (US)
Pages (from-to)824-830
Number of pages7
JournalClinical Chemistry
Volume62
Issue number6
DOIs
StatePublished - Jun 1 2016
Externally publishedYes

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Clinical Decision Support Systems
Intensive care units
Brain Natriuretic Peptide
Magnesium
Intensive Care Units
Inpatients
Calcium
Serum
Testing
Hypocalcemia
Electronic Health Records
Hospitalization
Health
Incidence
Population

ASJC Scopus subject areas

  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

Implementation of clinical decision support rules to reduce repeat measurement of serum ionized calcium, serum magnesium, and N-terminal pro-B-type natriuretic peptide in intensive care unit inpatients. / Moyer, Ann M.; Saenger, Amy K.; Willrich, Maria; Donato, Leslie J.; Baumann, Nikola A.; Block, Darci R.; Botz, Chad M.; Khan, Munawwar A.; Jaffe, Allan S.; Hanson, Curtis A.; Karon, Brad S.

In: Clinical Chemistry, Vol. 62, No. 6, 01.06.2016, p. 824-830.

Research output: Contribution to journalArticle

Moyer, Ann M. ; Saenger, Amy K. ; Willrich, Maria ; Donato, Leslie J. ; Baumann, Nikola A. ; Block, Darci R. ; Botz, Chad M. ; Khan, Munawwar A. ; Jaffe, Allan S. ; Hanson, Curtis A. ; Karon, Brad S. / Implementation of clinical decision support rules to reduce repeat measurement of serum ionized calcium, serum magnesium, and N-terminal pro-B-type natriuretic peptide in intensive care unit inpatients. In: Clinical Chemistry. 2016 ; Vol. 62, No. 6. pp. 824-830.
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abstract = "BACKGROUND: We assessed the impact of clinical decision support (CDS) rules within the electronic health record for ionized calcium (iCa), serum magnesium (Mg), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in intensive care unit (ICU) inpatients at a large academic center. METHODS: A repeat order for measurement of iCa or Mg placed within 24 (iCa) or 48 (Mg) h of a previously nonactionable result, or additional orders for NT-proBNP beyond 1 within a single hospitalization, triggered a CDS pop-up alert showing the prior result and offering the opportunity to cancel the order or to place the order after entering an indication for repeat testing. The number of tests performed for each of these analytes and incidence of adverse clinical outcomes potentially associated with hypocalcemia or hypomagnesemia were compared between the 90-day period before CDS implementation and two 90-day periods immediately following. RESULTS: iCa test volumes decreased by 48{\%}, Mg by 39{\%}, and NT-proBNP by 28{\%} in the 90-day period immediately following implementation and remained decreased by 54{\%}, 49{\%}, and 22{\%}, respectively, during the following 90-day period (all P values 0.17). CONCLUSIONS: Implementation of CDS dramatically decreased repeat testing of iCa, Mg, and NT-proBNP without adversely impacting clinical outcomes in the ICU. Expansion of the rules from the ICU units to include the entire hospitalized patient population and expansion to additional analytes is expected to lead to further reductions in testing.",
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T1 - Implementation of clinical decision support rules to reduce repeat measurement of serum ionized calcium, serum magnesium, and N-terminal pro-B-type natriuretic peptide in intensive care unit inpatients

AU - Moyer, Ann M.

AU - Saenger, Amy K.

AU - Willrich, Maria

AU - Donato, Leslie J.

AU - Baumann, Nikola A.

AU - Block, Darci R.

AU - Botz, Chad M.

AU - Khan, Munawwar A.

AU - Jaffe, Allan S.

AU - Hanson, Curtis A.

AU - Karon, Brad S.

PY - 2016/6/1

Y1 - 2016/6/1

N2 - BACKGROUND: We assessed the impact of clinical decision support (CDS) rules within the electronic health record for ionized calcium (iCa), serum magnesium (Mg), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in intensive care unit (ICU) inpatients at a large academic center. METHODS: A repeat order for measurement of iCa or Mg placed within 24 (iCa) or 48 (Mg) h of a previously nonactionable result, or additional orders for NT-proBNP beyond 1 within a single hospitalization, triggered a CDS pop-up alert showing the prior result and offering the opportunity to cancel the order or to place the order after entering an indication for repeat testing. The number of tests performed for each of these analytes and incidence of adverse clinical outcomes potentially associated with hypocalcemia or hypomagnesemia were compared between the 90-day period before CDS implementation and two 90-day periods immediately following. RESULTS: iCa test volumes decreased by 48%, Mg by 39%, and NT-proBNP by 28% in the 90-day period immediately following implementation and remained decreased by 54%, 49%, and 22%, respectively, during the following 90-day period (all P values 0.17). CONCLUSIONS: Implementation of CDS dramatically decreased repeat testing of iCa, Mg, and NT-proBNP without adversely impacting clinical outcomes in the ICU. Expansion of the rules from the ICU units to include the entire hospitalized patient population and expansion to additional analytes is expected to lead to further reductions in testing.

AB - BACKGROUND: We assessed the impact of clinical decision support (CDS) rules within the electronic health record for ionized calcium (iCa), serum magnesium (Mg), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in intensive care unit (ICU) inpatients at a large academic center. METHODS: A repeat order for measurement of iCa or Mg placed within 24 (iCa) or 48 (Mg) h of a previously nonactionable result, or additional orders for NT-proBNP beyond 1 within a single hospitalization, triggered a CDS pop-up alert showing the prior result and offering the opportunity to cancel the order or to place the order after entering an indication for repeat testing. The number of tests performed for each of these analytes and incidence of adverse clinical outcomes potentially associated with hypocalcemia or hypomagnesemia were compared between the 90-day period before CDS implementation and two 90-day periods immediately following. RESULTS: iCa test volumes decreased by 48%, Mg by 39%, and NT-proBNP by 28% in the 90-day period immediately following implementation and remained decreased by 54%, 49%, and 22%, respectively, during the following 90-day period (all P values 0.17). CONCLUSIONS: Implementation of CDS dramatically decreased repeat testing of iCa, Mg, and NT-proBNP without adversely impacting clinical outcomes in the ICU. Expansion of the rules from the ICU units to include the entire hospitalized patient population and expansion to additional analytes is expected to lead to further reductions in testing.

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