INTRODUCTION OF A COMPUTERIZED PROTOCOL IN CLINICAL-PRACTICE - IS THERE ANYTHING TO GAIN

Objectives: To assess the potential benefit of a protocol for the diag nostic work-up and management of patients with obstructive jaundice, b y comparing its recommendations with the policies actually followed in patients and to compare local expertise with diagnostic and therapeut ic procedures with that described in published reports. Design: A retr ospective analysis of patients' records. Setting: University hospital, The Netherlands. Subjects: 49 consecutive patients who presented to t he departments of internal medicine and surgery between June 1990 and June 1992 with serum alkaline phosphatase activities > 125 mu mol/L, a nd serum bilirubin concentrations > 17 mu mol/L. Main outcome measures : The proportions of diagnostic and therapeutic decisions that deviate d from the recommendations, and the success rates of diagnostic and th erapeutic procedures. Results: In patients with bile duct stones the t reatment strategies did not deviate from those recommended in the prot ocol. In patients with cancer 38 (30%) of the 128 diagnostic decisions and 4 (11%) of the 37 therapeutic decisions deviated from the protoco l. Success rates of all diagnostic investigations were comparable with those reported, and success rates of endoscopic biliary drainage tend ed to be lower than those reported. Conclusions: The introduction of a protocol for the diagnostic work-up of patients with obstructive jaun dice may reduce unnecessary investigations and diagnostic omissions by half. Because local expertise of some of the procedures seems to be s ignificantly less than reported elsewhere it may be necessary to modif y the protocol to better fit local circumstances.