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A Computer-Based Intervention for Improving the Appropriateness of Antiepileptic Drug Level Monitoring

Philip Chen MD, PhD, Milenko J. Tanasijevic MD, Ronald A. Schoenenberger MD, Julie Fiskio, Gilad J. Kuperman MD, PhD, David W. Bates MD, MSc
DOI: http://dx.doi.org/10.1309/A96XU9YKU298HB2R 432-438 First published online: 1 March 2003


We designed and implemented 2 automated, computerized screens for use at the time of antiepileptic drug (AED) test order entry to improve appropriateness by reminding physicians when a potentially redundant test was ordered and providing common indications for monitoring and pharmacokinetics of the specific AED. All computerized orders for inpatient serum AED levels during two 3-month periods were included in the study. During the 3-month period after implementation of the automated intervention, 13% of all AED tests ordered were canceled following computerized reminders. For orders appearing redundant, the cancellation rate was 27%. For nonredundant orders, 4% were canceled when information on specific AED monitoring and pharmacokinetics was provided. The cancellation rate was sustained after 4 years. There has been a 19.5% decrease in total AED testing volume since implementation of this intervention, despite a 19.3% increase in overall chemistry test volume. Inappropriateness owing to repeated testing before pharmacologic steady state was reached decreased from 54% of all AED orders to 14.6%. A simple, automated, activity-based intervention targeting a specific test-ordering behavior effectively reduced inappropriate laboratory testing. The sustained benefit supports the idea that computerized interventions may durably affect physician behavior. Computerized delivery of such evidence-based boundary guidelines can help narrow the gap between evidence and practice.

Key Words:
  • Antiepileptic drug level
  • Utilization
  • Benchmark
  • Indicators
  • Appropriateness
  • Guidelines
  • Test ordering
  • Evidence-based medicine