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

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• 作者：Hayley L. Merkeley ; MD^a ; Juliya Hemmett ; MD^a ; Tara A. Cessford ; MD^a ; Neda Amiri ; MD^a ; Georgia S. Geller ; MD^a ; Nazli Baradaran ; MD^a ; Monica Norena ; MS^b ; Hubert Wong ; PhD^b ; Najib Ayas ; MD ; MPH ; FRCPC^a ; ^b ; ^c ; Peter M. Dodek ; MD ; MHSc ; FRCPC^a ; ^b ; ^c ; ^{peter.dodek@ubc.ca" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Intensive care units ; Diagnostic tests ; Resource utilization
• 刊名：Journal of Critical Care
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：31
• 期：1
• 页码：212-216
• 全文大小：582 K

文摘

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.