Error reduction with web based clinical calculators linked to patient results
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ERROR REDUCTION WITH WEB-BASED CLINICAL CALCULATORS LINKED TO PATIENT RESULTS. Jones GRD and Tinker E Departments of Chemical Pathology and Information Training and Support Services, St Vincent’s Hospital, Sydney, Australia. Background.

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ERROR REDUCTION WITH WEB-BASED CLINICAL CALCULATORS LINKED TO PATIENT RESULTS.

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Error reduction with web based clinical calculators linked to patient results

ERROR REDUCTION WITH WEB-BASED CLINICAL CALCULATORS LINKED TO PATIENT RESULTS.

Jones GRD and Tinker E

Departments of Chemical Pathology and Information Training and Support Services, St Vincent’s Hospital, Sydney, Australia.

APCCB 2004


Background

Background

  • Biochemical test results are commonly used for calculations designed to gain further information for clinical decision making.

  • Possible errors with such calculations include:

    • data transcription errors

    • errors in writing the formula

    • calculation errors.

  • We have devised a web-based product aiming to reduce these errors.

APCCB 2004


Results reporting

Results Reporting

  • On campus all common pathology tests are reported on-line.

  • No paper reports are printed for inpatients.

  • The data is displayed in “Mediweb”

  • Mediweb is a web-based product developed in-house for results display.

  • Mediweb is available via intranet throughout campus.

  • There is a high level of user satisfaction with Mediweb (2003 user survey).

APCCB 2004


Medical calculations

Medical Calculations

  • Performance of biochemical calculations requires:

    • transcription of the results from the screen

    • knowledge of the formula

    • performance of the calculation

    • transcription of the result into the patient notes

  • Examples include:

    • Calcium correction for albumin

    • Osmolar and anion gaps

    • Creatinine clearance by Cockroft and Gault formula

    • Globulin and LDL calculations

APCCB 2004


The solution part 1

The Solution - part 1

Provision of Web-based calculators.

  • Equations displayed with spaces for data entry.

  • Data entry limits to avoid “ridiculous” transcription errors.

  • Result displayed with colour code to indicate inside/outside reference limit.

  • “Help” button for brief description of equation.

  • Avoids errors in recalling formula or performing calculation

APCCB 2004


The solution part 2

The Solution - part 2

Calculators linked to patient results.

  • Calculator can be opened with one click while reviewing patient results in Mediweb.

  • Patient details and relevant results are automatically entered into equations.

  • Spaces are left for data not in Mediweb (eg weight for Cockroft and Gault).

  • Sheet can be printed together with patient identifiers.

  • Avoids transcription errors into calculators

  • Provides written record if required.

APCCB 2004


Error reduction with web based clinical calculators linked to patient results

Example of on-line calculators.

  • Each calculator may be hidden or displayed

  • Help symbol provides further information

  • Blue input fields mark automatic data transfer

  • Pink input fields mark manual data entry required

  • Green Result fields indicate result within reference limits

  • Pull-down menu allows choice of other data set

APCCB 2004


Features

Features

  • Each calculator may be hidden or displayed

  • Help symbol provides further information

  • Blue input fields mark automatic data transfer

  • Pink input fields mark manual data entry required

  • Green Result fields indicate result within reference limits

  • Pull-down menu allows choice of other data set

APCCB 2004


Behind the scenes

Behind the Scenes

  • Mediweb written in HTML

  • Equations written in Javascript

  • Data transfer from Mediweb to Equations by Java array.

  • Process required collaboration between Pathology and IT Department.

  • Low cost project for planning and implementation.

APCCB 2004


Conclusions

Conclusions

  • We have provided a tool to make common biochemistry calculations easily available.

  • Common errors such as transcription, formula or calculation errors can be avoided.

  • Current usage is up to 25 times per day.

  • The product has been enthusiastically received by the medical and pharmacy staff.

  • Further calculators are planned.

APCCB 2004


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