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Emergency Department
Time Instensitive Predictive Instrument Information System
ED TIPI-IS
Reducing Medical Errors in Emergency Departments and Hospitals through real time, concurrent, and retrospective decision support.
ACUTE cardiac ischemia (ACI) is the most common serious condition requiring emergency and acute medical care. Each year in this country, over
six million patients come to emergency departments (EDs) with chest pain or other symptoms suggesting a cardiac problem; about 25% will prove
to have true ACI (including myocardial infarction [AMI] and unstable angina). To avoid missing those patients with true ACI, nearly double
this number are admitted unnecessarily. Nonetheless, about 2% of those with ACI, yearly about 12,000 patients with AMI and 14,000 with unstable
angina, are mistakenly sent home. This nearly doubles their expected mortality rate. As a result, perennially, ED cases of missed ACI represent a
major cost of adult medical malpractice claims in the US.
The Acute Cardiac Ischemia Time-Insensitive Predictive Instrument (ACI-TIPI) is a physician decision support tool that generates a patient's 0-100%
probability of having ACI, to help ED physicians gauge the patient's need for hospitalization. Developed through years of federally funded research,
the ACI-TIPI is available for most ED electrocardiographs in the United States. The TIPI Information System (TIPI-IS) takes the probabilities of ACI
generated by the ED electrocardiograph and combines them with patient specific information to create a powerful database and reporting system for medical
error prevention, clinical practice evaluation, and quality improvement.
Emergency Departments are particularly vulnerable to medical error. The acute nature of patients' presentations, the pressure to see and treat them
quickly, the heightened pressure to selectively hospitalize due to managed care, and the pressure to maintain patient satisfaction and short wait
times, all lead to a challenging environment for timely and accurate diagnosis and treatment. The ACI-TIPI and TIPI-IS help the physician deal
with this in real-time, while treating the patient, provide a safety net of concurrent alerts for high risk patients who need follow-up, and support
retrospective self review of practice patterns.
(link to TIPI-IS Brochure - PDF download)
TIPI-IS Benefits
Hospital-specific thresholds for ED alerts about potential medical errors (missed acute cardiac ischemia [ACI]).
Electronic alerting system to email, page, or other telecommunications systems.
Data collection through automated information system interfaces without additional hands-on data collection or entry.
Reports on ED patients discharged with high ACI-TIPI probabilities.
Reports on ED triage comparing average ACI-TIPI probabilities across physicians and disposition locations for quality and cost-effectiveness analysis.
Physician 24-hour access to TIPI-IS reports from own PC.
Patient Search and Drill-Down access to patient level detail.
Quality Manager system to identify, track, and report on the status of possible error alerts.
Performance Indicators on patient safety functions and clinical practice patterns.
A sample of quality measures
Time to first ECG
Door to balloon time
Door to Thrombolytic therapy time
Door to transfer for PCI
Door hospital A to door Hospital B to balloon time
Patients receive reperfusion when needed
EMS and ED integrated metrics. Such as; EMS-on-scene to Balloon Time
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Risk Management Features
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Benefit
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Diagnosis Related Problems (e.g., Failure to diagnose, delay in diagnosis, missed diagnosis)
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Provides reports on patients discharged home at risk of having an MI (patients discharged with high ACI TIPI probability > 55 %) Identifies
patients readmitted within 3 days for retrospective review & quality improvement. Provides decision support in real time to help ED physicians
identify patients with ACS (including myocardial infarction (AMI) and unstable angina) Physician specific reports that show you average
ACI/TIPI probabilities for groups of patients admitted or discharged. Key lab tests, ECGs, and diagnosis information provided for each patient.
Insert line about disparities (i.e., women)
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Failure to follow up on abnormal lab values
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Communicates critical test results to the ED physician of record & tracks follow up Alerts the physician electronically when a patient is
sent home from the ED with positive Cardiac Bio markers (e.g., abnormal Troponin and abnormal CK-MB) Provides a back-up mechanism for
follow-up on abnormal lab results
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Delay in Treatment
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Tracks time to treatment for patients where time is critical to patient outcome Provides time to treatment reports for use in
retrospective quality improvement activities
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Inadequate Documentation
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Generates a form to guide clinicians through the documentation of decision-making process and actions taken,
including differential diagnosis, treatment plan, and patient instructions.
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ED Diversion & Hospital Capacity
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Provides real-time decision-support to help identify patients in need of ICU/CCU bed Provides reports on patients sent
to the ICU/CCU with a low ACI-TIPI Probability Provides reports on patients admitted to ICU/CCU without an AMI diagnosis
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