Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] · 2026
Automated alert system and collaborative workflow improve treatment adherence and clinical outcomes in emergency care for acute pancreatitis: A quality improvement project.
СтатьяНазвание и аннотация: Перевод в очереди
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Pan Yingyu, Gao Xiaomao, Jiang Xiaodong, Wu Zuoyan, Li Jianing, Zhai Chunying, Cheng Xiaohe, Wang Pai, Xie Feng, Shi Di, Wu Dong
Аннотация
BACKGROUND: Early management of acute pancreatitis (AP) is vital for improving prognosis, yet a significant "know-do gap" persists in clinical practice due to suboptimal guideline adherence. This project aimed to enhance adherence to core early treatments for AP patients in the emergency department and to improve clinical outcomes.
METHODS: A multifaceted intervention was implemented, comprising: (1) an automated alert system for real-time case screening; (2) a emergency-gastroenterology collaborative workflow; (3) "Just-in-Time Coaching" to provide bedside decision support; and (4) a structured daily reporting system to ensure fidelity. Primary process measure was adherence to early goal-directed fluid resuscitation. Initiation of enteral nutrition within 72 h of admission was tracked as a secondary process measure. Clinical outcome measures included organ failure, intensive care unit admission and 6-month mortality. Fluid overload and alert fatigue were assessed as balancing measures.
RESULTS: Fluid resuscitation compliance increased significantly from 63.5% to 88.1% (OR = 5.34, p < 0.001). Enteral nutrition compliance showed a numeric increase (30.6% vs 43.5%) but didn't reach statistical significance. Regarding clinical outcomes, the intervention was associated with significantly reduced renal failure (17.6% vs 8.9%, aOR = 0.48, p = 0.043). No fluid overload events occurred in either phase. The alert system achieved 99.67% sensitivity with acceptable cognitive load.
CONCLUSIONS: The "automated alert system coupled with a collaborative workflow" model effectively bridged the "know-do gap" in a high-pressure emergency environment, standardizing care processes and improving clinical outcomes for AP patients.
METHODS: A multifaceted intervention was implemented, comprising: (1) an automated alert system for real-time case screening; (2) a emergency-gastroenterology collaborative workflow; (3) "Just-in-Time Coaching" to provide bedside decision support; and (4) a structured daily reporting system to ensure fidelity. Primary process measure was adherence to early goal-directed fluid resuscitation. Initiation of enteral nutrition within 72 h of admission was tracked as a secondary process measure. Clinical outcome measures included organ failure, intensive care unit admission and 6-month mortality. Fluid overload and alert fatigue were assessed as balancing measures.
RESULTS: Fluid resuscitation compliance increased significantly from 63.5% to 88.1% (OR = 5.34, p < 0.001). Enteral nutrition compliance showed a numeric increase (30.6% vs 43.5%) but didn't reach statistical significance. Regarding clinical outcomes, the intervention was associated with significantly reduced renal failure (17.6% vs 8.9%, aOR = 0.48, p = 0.043). No fluid overload events occurred in either phase. The alert system achieved 99.67% sensitivity with acceptable cognitive load.
CONCLUSIONS: The "automated alert system coupled with a collaborative workflow" model effectively bridged the "know-do gap" in a high-pressure emergency environment, standardizing care processes and improving clinical outcomes for AP patients.