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OBJECTIVE To evaluate the effect of an automatic alerting system on the time until treatment is ordered for patients with critical laboratory results. DESIGN Prospective randomized controlled trial. INTERVENTION A computer system to detect critical conditions and automatically notify the responsible physician via the hospital's paging system. PATIENTS(More)
OBJECTIVE Although computerized physician order entry (CPOE) may decrease errors and improve quality, hospital adoption has been slow. The high costs and limited data on financial benefits of CPOE systems are a major barrier to adoption. The authors assessed the costs and financial benefits of the CPOE system at Brigham and Women's Hospital over ten years.(More)
BACKGROUND In patients with acute coronary syndromes, it is desirable to identify a sensitive serum marker that is closely related to the degree of myocardial damage, provides prognostic information, and can be measured rapidly. We studied the prognostic value of cardiac troponin I levels in patients with unstable angina or non-Q-wave myocardial infarction.(More)
OBJECTIVE The purpose of the study is to determine how frequently critical laboratory results (CLRs) occur and how rapidly they are acted upon. A CLR was defined as a result that met either the critical reporting criteria used by the laboratory at Brigham and Women's Hospital or other, more complex criteria. DESIGN This is a retrospective cohort study in(More)
BACKGROUND Significant analytic variability exists between the multiple assays for cardiac troponin I (cTnI) approved for clinical use. Until adequate cTnI standardization is possible, an evidence-based approach evaluating each assay at specific thresholds appears warranted. METHODS We examined the efficacy of three cTnI assays for predicting death,(More)
While evidence-based medicine has increasingly broad-based support in health care, it remains difficult to get physicians to actually practice it. Across most domains in medicine, practice has lagged behind knowledge by at least several years. The authors believe that the key tools for closing this gap will be information systems that provide decision(More)
CONTEXT Short patient wait times are critical for patient satisfaction with outpatient phlebotomy services. Although increasing phlebotomy staffing is a direct way to improve wait times, it may not be feasible or appropriate in many settings, particularly in the context of current economic pressures in health care. OBJECTIVE To effect sustainable(More)
M any clinical chemistry laboratories perform troponin testing to aid in the diagnosis of acute coronary syndrome (ACS). Laboratories must interact with clinicians to establish diagnostic cut points, achieve acceptable assay performance, and troubleshoot questionable findings. Here we present 3 hypothetical scenarios related to tro-ponin testing in the(More)
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