Journal of Critical Care: Available online 25 September 2015
To reduce unnecessary ordering of routine-priority blood tests.
In this before-after study, we studied all patients admitted to a 15-bed tertiary ICU from July 1, 2011–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.
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. Non-routine CBCs and non-routine 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 one year in one ICU. There were no differences in demographics, severity of illness, length of stay, or number of red cell transfusions between the two periods.
Sequential interventions to discourage the ordering of routine-priority blood tests in an ICU was associated with a significant decrease in the number of tests ordered.