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

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.

journal_name

J Crit Care

journal_title

Journal of critical care

authors

Merkeley HL,Hemmett J,Cessford TA,Amiri N,Geller GS,Baradaran N,Norena M,Wong H,Ayas N,Dodek PM

doi

10.1016/j.jcrc.2015.09.013

subject

Has Abstract

pub_date

2016-02-01 00:00:00

pages

212-6

issue

1

eissn

0883-9441

issn

1557-8615

pii

S0883-9441(15)00473-6

journal_volume

31

pub_type

杂志文章

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