title: A combined paging alert and web-based instrument alters clinician behavior and shortens hospital length of stay in acute pancreatitis.
abstract: OBJECTIVE
  There are many published clinical guidelines for acute pancreatitis (AP). Implementation of these recommendations is variable. We hypothesized that a clinical decision support (CDS) tool would change clinician behavior and shorten hospital length of stay (LOS).
  
  
  METHODS
  
  
  
  METHODS
  Observational study, entitled, The AP Early Response (TAPER) Project. Tertiary center emergency department (ED) and hospital.
  
  
  METHODS
  Two consecutive samplings of patients having ICD-9 code (577.0) for AP were generated from the emergency department (ED) or hospital admissions. Diagnosis of AP was based on conventional Atlanta criteria. The Pre-TAPER-CDS-Tool group (5/30/06-6/22/07) had 110 patients presenting to the ED with AP per 976 ICD-9 (577.0) codes and the Post-TAPER-CDS-Tool group (5/30/06-6/22/07) had 113 per 907 ICD-9 codes (7/14/10-5/5/11).
  
  
  METHODS
  The TAPER-CDS-Tool, developed 12/2008-7/14/2010, is a combined early, automated paging-alert system, which text pages ED clinicians about a patient with AP and an intuitive web-based point-of-care instrument, consisting of seven early management recommendations.
  
  
  RESULTS
  The pre- vs. post-TAPER-CDS-Tool groups had similar baseline characteristics. The post-TAPER-CDS-Tool group met two management goals more frequently than the pre-TAPER-CDS-Tool group: risk stratification (P<0.0001) and intravenous fluids >6L/1st 0-24 h (P=0.0003). Mean (s.d.) hospital LOS was significantly shorter in the post-TAPER-CDS-Tool group (4.6 (3.1) vs. 6.7 (7.0) days, P=0.0126). Multivariate analysis identified four independent variables for hospital LOS: the TAPER-CDS-Tool associated with shorter LOS (P=0.0049) and three variables associated with longer LOS: Japanese severity score (P=0.0361), persistent organ failure (P=0.0088), and local pancreatic complications (<0.0001).
  
  
  CONCLUSIONS
  The TAPER-CDS-Tool is associated with changed clinician behavior and shortened hospital LOS, which has significant financial implications.
authors.affiliation: 1] Departments of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA [2] Division of Gastroenterology and Hepatology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Dimagno
authors.affiliation: 1] Departments of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA [2] Division of Gastroenterology and Hepatology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA.
authors.forename: Erik-Jan
authors.initials: EJ
authors.lastname: Wamsteker
authors.affiliation: 1] Departments of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA [2] Division of Gastroenterology and Hepatology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA.
authors.forename: Rafat S
authors.initials: RS
authors.lastname: Rizk
authors.affiliation: Departments of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA.
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Spaete
authors.affiliation: Departments of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA.
authors.forename: Suraj
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Departments of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA.
authors.forename: Tanya
authors.initials: T
authors.lastname: Sahay
authors.affiliation: Departments of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Costanzo
authors.affiliation: 1] Departments of Internal Medicine, University of Washington School of Medicine, Seattle, Washington, USA [2] Division of Gastroenterology and Hepatology, University of Washington School of Medicine, Seattle, Washington, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Inadomi
authors.affiliation: Division of Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan, USA.
authors.forename: Lena M
authors.initials: LM
authors.lastname: Napolitano
authors.affiliation: Division of Pulmonary and Critical Care, University of Michigan School of Medicine, Ann Arbor, Michigan, USA.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Hyzy
authors.affiliation: Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA.
authors.forename: Jeff S
authors.initials: JS
authors.lastname: Desmond
mesh_terms: D000208:Acute Disease; D000328:Adult; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D005260:Female; D006747:Hospital Communication Systems / Q000458:organization & administration*; D006801:Humans; D020407:Internet; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D050316:Medical Order Entry Systems; D008875:Middle Aged; D010195:Pancreatitis / Q000628:therapy*; D010820:Physicians / Q000523:psychology*; D010818:Practice Patterns, Physicians'