1997 OPEN FORUM Abstracts
UTILITY OF ALGORITHMS FOR PULMONARY FUNCTION TESTS IN HOSPITALIZED PATIENTS
K. White CPFT, N. Mangalindan RRT, K. McCarthy RCPT, M. Kavuru MD. The Cleveland Clinic Foundation, Cleveland, OH 44195.
Background: In our large teaching hospital, inpatient physician orders are entered into an electronic Order Entry system (OE) by ward secretaries. Since the inception of this system in 1996, a large percentage of the orders requested via OE have been for 'complete pulmonary function studies'. We undertook prospective data collection to help us understand this phenomenon. Method: During the collection period 2/29/97 through 3/13/97, for all consecutive in-patient requests for pulmonary function, we prospectively collected the following information on each request: physician order (as written), the order chosen by the ward secretaries from the OE list, diagnosis(es), pending surgery and site of pending surgery. We examined the orders as written to determine if the order was specific (e.g. spirometry and diffusing capacity) or vague (e.g. PFTs). We compared the physician order with the order entry request. When a vague written order was present, the technicians examined the patient's medical record to determine what test(s) were medically indicated. Results: Fifty requests for pulmonary function tests were received. Of these, 22 (44%) were completely vague (e.g. PFTs) and another 9(18%) were at least partially vague (e.g. PFTs with DLCO). The remainder of the physician orders specified the test sufficiently. Thirty (97%) partially or completely vague orders were entered into OE as "complete pulmonary function studies" a term defined by the system as spirometry, lung volumes by helium dilution and diffusing capacity (DLCO). In 18 cases (82%) where the orders were completely vague, spirometry was the only pulmonary function test deemed to be medically necessary. Of the remainder of the cases in which the written order was completely vague, the tests deemed medically necessary were: spirometry, lung volumes and DLCO in two cases (11%), spirometry with DLCO in one case (6%) and spirometry, DLCO and arterial blood gas, one case (6%). In the nine cases where the orders were partially vague, spirometry and DLCO were deemed necessary in all cases (100%). Conclusions: 1. Physician orders for inpatient pulmonary function testing are often completely or partially vague. 2. Ward secretaries at our institution routinely translate vague written orders into electronic orders for complete pulmonary function tests. 3. When pre-defined appropriateness criteria are used to determine what test is necessary, more expedient, less costly testing is the result in the majority of cases. Discussion: In teaching hospitals, there is a high turnover of resident physicians and vague orders are common. The use of pre-determined algorithms by the Pulmonary Lab technologists to determine the test(s) to be performed may be an alternative to the current system.