Introduction of a computerised protocol in clinical practice: is there anything to gain?
OBJECTIVE
To assess the potential benefit of a protocol for the diagnostic work-up and management of patients with obstructive jaundice, by comparing its recommendations with the policies actually followed in patients and to compare local expertise with diagnostic and therapeutic procedures with that described in published reports.


METHODS
A retrospective analysis of patients' records.


METHODS
University hospital, The Netherlands.


METHODS
49 consecutive patients who presented to the departments of internal medicine and surgery between June 1990 and June 1992 with serum alkaline phosphatase activities > 125 mumol/L, and serum bilirubin concentrations > 17 mumol/L.


METHODS
The proportions of diagnostic and therapeutic decisions that deviated from the recommendations, and the success rates of diagnostic and therapeutic procedures.


RESULTS
In patients with bile duct stones the treatment strategies did not deviate from those recommended in the protocol. In patients with cancer 38 (30%) of the 128 diagnostic decisions and 4 (11%) of the 37 therapeutic decisions deviated from the protocol. Success rates of all diagnostic investigations were comparable with those reported, and success rates of endoscopic biliary drainage tended to be lower than those reported.


CONCLUSIONS
The introduction of a protocol for the diagnostic work-up of patients with obstructive jaundice may reduce unnecessary investigations and diagnostic omissions by half. Because local expertise of some of the procedures seems to be significantly less than reported elsewhere it may be necessary to modify the protocol to better fit local circumstances.
Vissers
M C
MC
Department of Medical Informatics, University of Limburg, The Netherlands.
Greve
J W
JW
Gouma
D J
DJ
van der Linden
C J
CJ
Hasman
A
A
D000368:Aged; D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000601:surgery; D001661:Biliary Tract Neoplasms / Q000150:complications; D002758:Cholangiography / Q000379:methods; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D002769:Cholelithiasis / Q000150:complications; D002779:Cholestasis / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D002985:Clinical Protocols / Q000592:standards; D016001:Confidence Intervals; D003658:Decision Making, Computer-Assisted; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed