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

1. 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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