Date: 16 Aug 2014

Capsule Commentary on Larochelle et al., Reducing Excess Biomarker Testing at an Academic Medical Center

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Larochelle et al.1 test a multimodality intervention to prevent unnecessary use of CK and CK-MB testing and overuse of troponin testing in the diagnosis of cardiac chest pain. The authors modified the electronic medical record cardiac order set, removing the option for CK and CK-MB testing and promoting serial troponin ordering in adherence with established guidelines. In addition, the authors conducted informational sessions related to the above guidelines and distributed pocket cards for information reinforcement. The study, completed as an interrupted times series design, cited an absolute increase of guideline-concordant ordering of cardiac biomarkers of 38.4 % with an associated $1.25 million decrease in charges over the first year.

This paper is an excellent example of how a “forced” intervention of EMR modifications can be combined with a weaker intervention based on educational sessions to create clinically meaningful and sustainable results through the use of quality improvemen ...

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