Effectively reducing amylase testing using computer order entry in the emergency department: quality improvement without eliminating physician choice.

BACKGROUND: Amylase and lipase, pancreatic biomarkers, are measured in acute pancreatitis diagnosis. Since amylase testing does not add diagnostic value, lipase testing alone is recommended. Despite new recommendations, many physicians and staff continue to test both amylase and lipase. OBJECTIVE: To reduce unnecessary diagnostic testing in acute pancreatitis. METHODS: The pre-checked amylase test within the Emergency Department's Computerized Provider Order Entry (CPOE) abdominal pain order set was changed to an un-checked state, but kept as an option to order with a single click. Amylase testing, lipase testing and cost were measured for one year pre and post intervention. RESULTS: Simple de-selection intervention reduced redundant amylase testing from 71% to 9%, resulting in a percent of decrease of 87% and an annualized saving of approximately $719,000 in charges. CONCLUSION: CPOE de-selection is an effective tool to reduce non-value added activity and reduce cost while maintaining quality patient care and physician choice.