Strategies to Reduce Inappropriate Laboratory Blood Test Orders in Intensive Care Are Effective and Safe: A Before-And-After Quality Improvement Study (original) (raw)
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Clinical Medicine
Haematology inpatients are subject to extensive blood testing and many of these tests could be deemed inappropriate as they are not indicated for monitoring or clinical symptoms. Unnecessary testing exposes the patient to the risks of phlebotomy and adds resources' strain to the NHS. Our aim was to reduce the number of inappropriate blood tests performed on haematology inpatient wards. Quality improvement projects (QIPs) were performed in four haematology units introducing inpatient blood testing schedules (BTS) or providing staff education on current schedules. A reduction in inappropriate or overall blood testing was achieved at every site where a BTS was implemented, with a median reduction in inappropriate blood testing of 24.7% and estimated cost savings of up to £38,438 per annum. This QIP can be safely adapted to a variety of inpatient settings and is associated with cost savings. This initiative could be extended to other inpatient departments throughout the NHS.
Decreasing unnecessary laboratory testing in medical critical care
Advances in Clinical Medical Research and Healthcare Delivery
The overuse of laboratory testing is common in the intensive care unit (ICU) which leads to an increased cost of care and an increased potential for harm to the patient. There is no evidence that obtaining daily laboratory tests helps to reduce mortality or morbidity in critical care patients. We conduced a retrospective study where chart review was performed to assess the frequency of unnecessary laboratory testing followed by a quality improvement initiative. With our study we were successful at reducing the inappropriate laboratory testing and improving the appropriate laboratory testing through our study.
Non-essential blood tests in the intensive care unit: a prospective observational study
Canadian journal of anaesthesia = Journal canadien d'anesthesie, 2017
Non-essential blood testing in the acute care setting can be a prominent source of morbidity, patient discomfort, increased workload for the healthcare provider, and wasteful spending. The magnitude of such non-essential blood testing has not been well described. We aimed to measure the extent of unnecessary blood testing in a 33-bed intensive care unit (ICU) at a tertiary-care teaching hospital in Ontario, Canada. Over a period of four weeks, all ICU attending physicians were asked to select, from a comprehensive list, blood tests that they deemed essential to the appropriate care for each of their patients on the following day. The actual tests processed on the following day were recorded. Descriptive statistics were used to determine what proportion of all processed tests were deemed essential blood tests. The association between patient characteristics and the total cost of unnecessary tests was assessed using the Wilcoxon rank-sum test and the Spearman correlation coefficient, ...
International Journal of Clinical Practice
Background: Reducing unnecessary laboratory blood testing in the hospital setting represents a challenge to improve the adequacy of healthcare and a tricky task for teaching hospitals. Our hospital network actively participates in the Choosing Wisely Campaign and is engaged in avoiding unnecessary low value interventions and investigations. We aimed to study whether a multi-level approach combining educational and web-system based interventions, could be effective in reducing laboratory testing and related costs. Methods: Multicenter, proof of concept, prospective, observational, before and after study, in a network of public hospitals in Switzerland. All patients admitted between 1 January 2015 and 31 December 2017 were analyzed. A multi-level strategy based on online continuous monitor benchmarking and educational support was applied in the internal medicine services. The primary outcome was a significant reduction in the number of laboratory tests per patient and per day during the hospital stay. Secondary outcomes were reduction in the blood sample volume taken per patient and per day in laboratory costs. Results: Over the 36 months of the study, 33 309 admissions were analyzed. A significant reduction of laboratory tests per patient and per day of hospitalisation was found:-11%, P-value<0.001;-6%, P-value <0.001. The mean monthly blood volume, per patient and per day of hospital stay and laboratory costs per patient was also significantly re
Improving Quality of Patient Care in an Emergency Department: Laboratory Perspective
American Journal of Clinical Pathology, 2008
The purpose of our study was to improve the quality of care in an emergency department (ED) as measured by length of stay (LOS), total turnaround time (TAT) for laboratory result reporting, and the blood culture contamination rate. Data were included for patients who had at least 1 of 5 laboratory tests performed as part of their care. The study was conducted in 2 phases. First, phlebotomy was performed by a dedicated phlebotomist or nonlaboratory personnel. The second phase added a dedicated laboratory technologist. There was a significant reduction in total TAT for all tests (at least 46 and 75 minutes in the respective interventions), and blood culture contamination rates dropped from 5.0% to 1.1%, although the overall LOS did not change. Estimated cost avoidance is more than $400,000 annually. Quality of care in an ED is improved when samples are collected by a dedicated phlebotomist, but overall LOS does not change.
American Journal of Medical Quality, 2017
Point of care (POC) laboratory testing is used to improve emergency department (ED) throughput but often overuses resources by duplicating formal laboratory testing. This study sought to evaluate the effect of a multimodal intervention on duplicate chemistry testing. This pre-post analysis included all visits to 2 urban EDs between June 2014 and June 2016. The multimodal intervention including provider education, signage, electronic health record redesign, and audit and feedback focused on reducing duplicate chemistry testing. The primary outcome was the number of duplicate chemistry tests per 100 visits. Autoregressive integrated moving-average models were used to account for secular changes. A total of 299 701 ED visits were included. The daily number of duplicate chemistry and POC chemistry tests significantly decreased following the intervention (3.3 fewer duplicates and 10.2 fewer POC per 100 ED visits, P < .0001). This implementation of a multimodal quality improvement intervention yielded substantial reductions in the overuse of blood chemistry testing in the ED.
Rationalising Routine PathologyInvestigations in the Intensive Care Unit
2021
Routine blood tests are costly and are ordered daily for patients in Intensive Care Units with no clear uniform guidelines in Australia. Junior Medical Officers (JMO) is routinely given this task of ordering daily blood tests, often without an understanding of the cost involved or of the significance of each test. This single centre, prospective, interventional study investigates the impact of having ICU specialists authorise routine daily blood tests in comparison to historical data where blood tests had been ordered by a JMO. Any adverse events in relation to not ordering blood tests were recorded. The number of patients admitted to the ICU, the median length of stay and Acute Physiology and Chronic Health Evaluation (APACHE) III scores were comparable during this time to historical data. The total number of tests decreased by 29% (P= 0.0001) and a decreased cost of 20% (P=0.0001). The ordering of routine blood tests by ICU specialists resulted in significant decrease in blood tes...