title: Eliminating amylase testing from the evaluation of pancreatitis in the emergency department.
abstract: BACKGROUND
  Alterations in serum biomarkers have been used to evaluate for pancreatitis in the emergency department (ED). Studies have shown lipase to be as sensitive and more specific than amylase in diagnosing pancreatitis and that amylase plus lipase does not improve accuracy over lipase alone.
  
  
  OBJECTIVE
  To determine effects of interventions to decrease ordering of amylase in the evaluation of pancreatitis.
  
  
  METHODS
  We conducted a pre- and post-cohort study. The number of amylase and lipase tests ordered in the ED was recorded prior to intervention to establish a baseline. We introduced an educational intervention to order lipase without amylase. A second intervention involved removing amylase from bedside order entry forms. We introduced a third intervention that included deleting amylase from trauma order forms, and decoupling amylase and lipase in the computer ordering system. We recorded the number of lipase and amylase tests in weekly aggregates for comparison to the baseline. Data analysis using students t-test, standard deviation and p values are reported.
  
  
  RESULTS
  Before interventions 93% of patients had both tests ordered. Educational interventions resulted in a decrease to 91% (p=0.06) of co-ordering. Further interventions decreased the percentage of patients evaluated with both tests to 14.3%. This translates into a decrease in patient charges of approximately $350,000 a year.
  
  
  CONCLUSIONS
  Using simple structured interventions in the ED can reduce amylase ordering. Educational programming alone was not effective in significantly decreasing amylase ordering; however, education plus system-based interventions decreased amylase ordering.
authors.affiliation: Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, MA.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Volz
authors.forename: Daniel C
authors.initials: DC
authors.lastname: McGillicuddy
authors.forename: Gary L
authors.initials: GL
authors.lastname: Horowitz
authors.forename: Richard E
authors.initials: RE
authors.lastname: Wolfe
authors.forename: Nina
authors.initials: N
authors.lastname: Joyce
authors.forename: Leon D
authors.initials: LD
authors.lastname: Sanchez