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J Crit Care. 2016 Feb;31(1):212-6. doi: 10.1016/j.jcrc.2015.09.013. Epub 2015 Sep 25.

Multipronged strategy to reduce routine-priority blood testing in intensive care unit patients.

Author information

1
Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
2
Center for Health Evaluation and Outcome Sciences, St Paul's Hospital and University of British Columbia, Vancouver, BC, Canada V6Z1Y6.
3
Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Center for Health Evaluation and Outcome Sciences, St Paul's Hospital and University of British Columbia, Vancouver, BC, Canada V6Z1Y6; Division of Critical Care Medicine, St Paul's Hospital and University of British Columbia, Vancouver, BC, Canada.
4
Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Center for Health Evaluation and Outcome Sciences, St Paul's Hospital and University of British Columbia, Vancouver, BC, Canada V6Z1Y6; Division of Critical Care Medicine, St Paul's Hospital and University of British Columbia, Vancouver, BC, Canada. Electronic address: peter.dodek@ubc.ca.

Abstract

PURPOSE:

The purpose of the study is to reduce unnecessary ordering of routine-priority blood tests.

METHODS:

In this before-after study, we studied all patients admitted to a 15-bed tertiary intensive care unit (ICU) from July 1, 2011, to June 27, 2013. Based on input from intensivists, acceptable indications for ordering routine-priority complete blood counts (CBCs) and electrolyte/renal panels were developed. Sequential interventions were (1) education sessions for ICU housestaff about the lack of evidence for routine-priority blood tests; (2) an item on the ICU rounds checklist to ask if routine-priority blood tests were indicated; (3) a rubber stamp, "routine bloodwork NOT indicated for tomorrow," was used in the chart; (4) a prompt in the electronic ordering system to allow only accepted indications; and (5) a second educational session for ICU housestaff. We measured numbers of tests done before and after these interventions.

RESULTS:

After introduction of interventions, there were 0.14 fewer routine-priority CBCs and 0.13 fewer routine-priority electrolyte/renal panels done per patient-day. Nonroutine CBCs and nonroutine electrolyte/renal panels increased by 0.03 and 0.02 tests per patient-day, respectively. This overall reduction in tests equates to an adjusted savings of $11,200.24 over 1 year in 1 ICU. There were no differences in demographics, severity of illness, length of stay, or number of red cell transfusions between the 2 periods.

CONCLUSION:

Sequential interventions to discourage the ordering of routine-priority blood tests in an ICU were associated with a significant decrease in the number of tests ordered.

KEYWORDS:

Diagnostic tests; Intensive care units; Resource utilization

PMID:
26476580
DOI:
10.1016/j.jcrc.2015.09.013
[Indexed for MEDLINE]

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