title: Using the Electronic Medical Record to Reduce Unnecessary Ordering of Coagulation Studies for Patients with Chest Pain.
abstract: BACKGROUND
  Our goal was to reduce ordering of coagulation studies in the emergency department (ED) that have no added value for patients presenting with chest pain. We hypothesized this could be achieved via implementation of a stopgap measure in the electronic medical record (EMR).
  
  
  METHODS
  We used a pre and post quasi-experimental study design to evaluate the impact of an EMR-based intervention on coagulation study ordering for patients with chest pain. A simple interactive prompt was incorporated into the EMR of our ED that required clinicians to indicate whether patients were on anticoagulation therapy prior to completion of orders for coagulation studies. Coagulation order frequency was measured via detailed review of randomly sampled encounters during two-month periods before and after intervention. We classified existing orders as clinically indicated or non-value added. Order frequencies were calculated as percentages, and we assessed differences between groups by chi-square analysis.
  
  
  RESULTS
  Pre-intervention, 73.8% (76/103) of patients with chest pain had coagulation studies ordered, of which 67.1% (51/76) were non-value added. Post-intervention, 38.5% (40/104) of patients with chest pain had coagulation studies ordered, of which 60% (24/40) were non-value added. There was an absolute reduction of 35.3% (95% confidence interval [CI]: 22.7%, 48.0%) in the total ordering of coagulation studies and 26.4% (95% CI: 13.8%, 39.0%) in non-value added order placement.
  
  
  CONCLUSIONS
  Simple EMR-based interactive prompts can serve as effective deterrents to indiscriminate ordering of diagnostic studies.
authors.affiliation: Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland.
authors.forename: Jeremiah S
authors.initials: JS
authors.lastname: Hinson
authors.affiliation: Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland.
authors.forename: Binoy
authors.initials: B
authors.lastname: Mistry
authors.affiliation: Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland.
authors.forename: Yu-Hsiang
authors.initials: YH
authors.lastname: Hsieh
authors.affiliation: Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Risko
authors.affiliation: Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland.
authors.forename: David
authors.initials: D
authors.lastname: Scordino
authors.affiliation: Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland.
authors.forename: Karolina
authors.initials: K
authors.lastname: Paziana
authors.affiliation: Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland.
authors.forename: Susan
authors.initials: S
authors.lastname: Peterson
authors.affiliation: Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland.
authors.forename: Rodney
authors.initials: R
authors.lastname: Omron
mesh_terms: D000328:Adult; D001778:Blood Coagulation Disorders / Q000175:diagnosis; D001780:Blood Coagulation Tests / Q000191:economics*; D002637:Chest Pain / Q000175:diagnosis*; D020000:Decision Support Systems, Clinical / Q000191:economics / Q000706:statistics & numerical data; D003955:Diagnostic Tests, Routine; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D055416:Evidence-Based Emergency Medicine / Q000191:economics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D019564:Unnecessary Procedures / Q000191:economics*