Computerized ordering tool cuts imaging cardiac stress tests
Zachary M. Gertz, M.D., from the Virginia Commonwealth University in Richmond, and colleagues developed a computerized order entry tool intended to reduce imaging cardiac stress test use and improve appropriate use among hospitalized patients. The tool was assessed by comparing preimplementation and postimplementation cohorts at a single academic teaching hospital (478 and 463 patients, respectively).
The researchers found that the indication was chest pain and preoperative in 66 and 18 percent of cases, and did not differ significantly between the groups. There was an increase in use of nonimaging stress tests from 4 to 15 percent in the pre-group and post-group (P < 0.001). The use of nonimaging stress tests increased from 7 to 25 percent among very low-risk chest pain patients (P < 0.001). There was no significant change in inappropriate tests (12 versus 11 percent); the most common inappropriate tests were preoperative evaluations (83 percent).
"Our computerized ordering tool significantly increased the use of nonimaging cardiac stress tests and reduced the use of imaging tests yet was not able to reduce inappropriate use," the authors write. "Our study highlights the differences in cardiac stress testing between hospitalized and ambulatory patients."
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