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Using Specialized Information Technology to Reduce Errors in Emergency Cardiac Care

Abstract : Information Technology (IT) solutions to patient safety/medical error problems are promising, but only in the early stages of their development and implementation. Many current IT applications for patient safety are focused on hospital processes, such as physician order entry and clinical information system based alerts for critical values. These interventions are broadly based, often targeting all medications ordered or all critical values for all patients, and, by necessity, are not specifically configured to address the care of patients with a particular condition or clinical problem. However, a condition- or problem-oriented IT system might better integrate into the care of frequent conditions and thereby be more effective. Accordingly, the authors focused on the use of IT for the most common serious conditions requiring emergency and acute care the diagnosis, triage, and treatment of emergency department (ED) patients with potential acute coronary syndrome (ACS). This condition includes acute myocardial infarction (AMI), also known as acute cardiac ischemia (ACI), and unstable angina pectoris (UAI), a condition that can lead to AMI. The Acute Cardiac Ischemia Time-Insensitive Predictive Instrument Information System (ACI-TIPI-IS) Demonstration Project at Tufts New England Medical Center used multiple IT applications for patient safety, combining real-time decision support, alerting, and retrospective feedback for performance improvement, all for the care of patients presenting to the ED with symptoms suggestive of ACS. A Web-based relational database system, the TIPI-IS, electronically compiled information from existing operational systems about all ED patients for whom an electrocardiogram (ECG) was done for possible ACS symptoms, and supported the patient safety aspects of the project. Real-time decision support was provided by the automatic printing of the probability of ACS on the ECG, as calculated by the ACI-TIPI.