APCCB ERROR REDUCTION WITH WEB-BASED CLINICAL CALCULATORS LINKED TO PATIENT RESULTS. Jones GRD and Tinker E Departments of Chemical Pathology and Information Training and Support Services, St Vincent’s Hospital, Sydney, Australia.

APCCB Background Biochemical test results are commonly used for calculations designed to gain further information for clinical decision making. Possible errors with such calculations include: –data transcription errors –errors in writing the formula –calculation errors. We have devised a web-based product aiming to reduce these errors.

APCCB Results Reporting On campus all common pathology tests are reported on- line. No paper reports are printed for inpatients. The data is displayed in “Mediweb” Mediweb is a web-based product developed in-house for results display. Mediweb is available via intranet throughout campus. There is a high level of user satisfaction with Mediweb (2003 user survey).

APCCB Medical Calculations Performance of biochemical calculations requires: –transcription of the results from the screen –knowledge of the formula –performance of the calculation –transcription of the result into the patient notes Examples include: –Calcium correction for albumin –Osmolar and anion gaps –Creatinine clearance by Cockroft and Gault formula –Globulin and LDL calculations

APCCB The Solution - part 1 Provision of Web-based calculators. Equations displayed with spaces for data entry. Data entry limits to avoid “ridiculous” transcription errors. Result displayed with colour code to indicate inside/outside reference limit. “Help” button for brief description of equation. Avoids errors in recalling formula or performing calculation

APCCB The Solution - part 2 Calculators linked to patient results. Calculator can be opened with one click while reviewing patient results in Mediweb. Patient details and relevant results are automatically entered into equations. Spaces are left for data not in Mediweb (eg weight for Cockroft and Gault). Sheet can be printed together with patient identifiers. Avoids transcription errors into calculators Provides written record if required.

APCCB Example of on-line calculators. Each calculator may be hidden or displayed Help symbol provides further information Blue input fields mark automatic data transfer Pink input fields mark manual data entry required Green Result fields indicate result within reference limits Pull-down menu allows choice of other data set

APCCB Features Each calculator may be hidden or displayed Help symbol provides further information Blue input fields mark automatic data transfer Pink input fields mark manual data entry required Green Result fields indicate result within reference limits Pull-down menu allows choice of other data set

APCCB Behind the Scenes Mediweb written in HTML Equations written in Javascript Data transfer from Mediweb to Equations by Java array. Process required collaboration between Pathology and IT Department. Low cost project for planning and implementation.

APCCB Conclusions We have provided a tool to make common biochemistry calculations easily available. Common errors such as transcription, formula or calculation errors can be avoided. Current usage is up to 25 times per day. The product has been enthusiastically received by the medical and pharmacy staff. Further calculators are planned.