Utilization of clinical guidelines for laboratory evaluation of suspected gallbladder or pancreatic pathology

The purpose of this study was to evaluate whether emergency health care practitioners utilize diagnostic laboratory testing consistent with the guidelines promulgated by the American College of Emergency Physicians (ACEP). In 1994, the Clinical Policy for the Initial Approach to Patients Presenting With a Chief Complaint of Nontraumatic Acute Abdominal Pain was approved by the ACEP board. This policy statement provided suggested guidelines for the diagnostic work-up and treatment for patients presenting with acute abdominal pain. The utilization of established medical protocols for diagnostic testing is closely aligned to the general practice of family nurse practitioners (Murphy, 1997).

This non-experimental, retrospective study involved the review of emergency department medical charts for adult patients with a discharge diagnosis related to cholelithiasis, cholecystitis, and/ or pancreatitis. Permission from the medical center nursing research approval committee was obtained prior to the initiation of data collection. Fifty charts were reviewed comparing the laboratory diagnostic evaluation of this sample with the established ACEP guidelines. This study found that diagnostic testing was consistent with the ACEP guide for gallbladder disease 70% of the time and 77% of the time for pancreatic disease, when excluding the requirement for serum calcium for the pancreatic evaluation. Strict adherence to the pancreatic policy produced an outcome of only 12% compliance with recommended testing.