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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

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

slide7
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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