A Utilization Management Intervention to Reduce Unnecessary Testing in the Coronary Care Unit

Wang, Thomas J.; Mort, Elizabeth; Nordberg, Paul; Chang, Yuchiao; Cadigan, Mary E.; Mylott, Laura; Ananian, Lillian; Thompson, B. Taylor; Fessler, Michael B.; Warren, W; Wheeler, Amy; Jordan, Mark; Fifer, Michael A.

doi:10.1001/archinte.162.16.1885

Cited by 103 publications

(75 citation statements)

References 15 publications

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“…Various interventions like education, guideline management and computer model have been practiced to reduce the laboratory utilization. Wang et al [8] demonstrated the modest reduction in routine testing after development of guideline, order template design and education. Computer based model reminding the physician about the redundant laboratory test has been effective to some extent to reduce the number of test performed [9].…”

Section: Discussionmentioning

confidence: 99%

Untitled

2016

JACCOA

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Context: There has been very few publications answering why the Arterial Blood Gas (ABG) test being ordered and whether its results affected patient management. Dissemination of guidelines, educational efforts can help in decreasing the unnecessary utilization of ABG thereby reducing the costs and complication Aims: To describe the pattern of Arterial Blood Gas utilization in a tertiary intensive care unit. Settings and Design:This prospective observational study was conducted in the adult ICU consisting of 11 beds. Methods and Material:About 486 ABG tests were performed and analyzed during three months duration. The clinician filled out ABG utilization proforma after test was done. Results:The common reasons for requesting an ABG test were routine (60.28%), following respiratory events (11.72%), and follow up on abnormal reports (9.25%). The clinicians considered PO2, pH, and PCO2 the most important parameters in the ABG test results. Of the results, there was no intervention in 52.2% cases and ventilator settings were changed only in 29.8% of cases. Conclusion:Oftentimes, many ABG tests were ordered as part of a routine investigation. ABG Analysis was done without test results influencing patient management.Keywords: Arterial blood gas; Intensive care unit; Utilization IntroductionThe arterial blood gas (ABG) is a frequently ordered laboratory test. Laboratory tests should be ordered to make accurate diagnoses, change management, monitor the response to management [1,2]. The continued frequency of ABG valuation may be influenced by routine work-patterns and easy access via arterial lines [3]. Many laboratory analysis including ABG are repeated too early [4]. Inappropriate utilization and blood collection not only escalate cost but may also create unnecessary patient discomfort and complications [5]. Ancillary expenditures in the intensive care setting can be decreased without compromising care of the patient [6]. Implementation of practice guidelines for blood gas measurement has been shown to decrease test utilization without affecting outcome [7].We decided to examine ABG test utilization patterns in our Intensive Care Unit (ICU) in an attempt to identify opportunities for improved utilization. We studied why the ABG test being ordered and whether its results affected patient management. Subjects and MethodsThe ethical approval was taken from ethical committee of the hospital. This prospective observational study was conducted in the adult ICU consisting of 11 beds. ABG tests performed outside ICU were not included in this study. The blood gas analyzers are validated to report arterial pH, PCO2, PO2, oxygen saturation, hemoglobin, hematocrit, sodium, potassium, ionized calcium, and whole blood glucose values.The clinician (doctor or nurse) filled out the ABG Survey form after ABG test was done. The utilization survey inquired about the reason for ordering the ABG test, the most important parameters used, and the effect of the results on patient management. The data collection took approximately three...

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Section: Discussionmentioning

confidence: 99%

Untitled

2016

JACCOA

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“…The possible explanation could be that the requesting physician ordered unnecessary tests for those patients. Inappropriate use of the laboratory has been widely documented in clinical practice (10)(11)(12).…”

Section: Discussionmentioning

confidence: 99%

Efficiency of test report delivery to the requesting physician in an outpatient setting: an observational study

Šimundić

Nikolac²,

Miler³

et al. 2009

Clinical Chemistry and Laboratory Medicine

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Background: Clinical laboratories accredited according to ISO 15189 quality standards are obliged to implement and continuously monitor quality indicators for evaluation of the laboratory's contribution to patient care. Reporting laboratory results to the requesting physician is one important phase of the clinical laboratory testing process. Failure to report results may indicate the ineffectiveness of the laboratory service. We aimed to analyze the proportion and type of laboratory reports for outpatients that were not delivered to the requesting physician. Methods: This retrospective observational study was conducted during an 11-month period from January to December 2007 at our outpatient biochemistry laboratory unit. Data on demographic characteristics, request types and laboratory findings for all uncollected reports were retrieved from the laboratory information system and compared with one random 2-week representative period. Results: During the study period our laboratory issued 22,445 patient reports with more than 150,000 biochemistry analyses. Of these, 464 (2.1%) were uncollected laboratory reports. When compared to the representative period, patients who never collected their laboratory reports were younger (p-0.001) or suffering from some chronic disease. Routine biochemistry tests were the most prevalent ()50%). The majority of routine biochemistry tests were almost equally represented during the study and representative period, while molecular diagnostic tests were several times more frequently uncollected (p-0.001). Reports with electrolytes, metabolites and glucose were the least likely to be uncollected (p-0.001). The total cost for those tests was 30% of the average monthly laboratory budget. Conclusions: A significant amount of the laboratory budget is wasted for tests that never reach the requesting physician. Such misutilization of the laboratory reveals the substantial lack of medical necessity for test requests. Further studies are needed to explore the possible efficiency of the various inter-

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“…Although many articles were recently published on demand management, few have looked at the impact on patient outcomes. Wang et al 22 assessed strategies to reduce unnecessary testing in a coronary care unit and found that reduced testing did not have any adverse effects on outcomes but the power of the study to assess outcomes was limited. Measuring clinical outcomes is difficult as the impact of changes in laboratory testing is unlikely to be sufficiently large to produce statistically significant changes in unequivocal endpoints such as death or hospitalisation, and surrogate endpoints are therefore needed.…”

Section: Hba1cmentioning

confidence: 99%

Demand management: an audit of chemical pathology test rejections by an electronic gate-keeping system at an academic hospital in Cape Town

2014

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Background: Demand management is an area of laboratory activity, which is becoming increasingly important. Within the health-care system, demand management can be defined as the use of health resources to maximise its utility. Tygerberg Hospital has introduced an electronic gate-keeping system. Chemistry tests which generate the highest cost are subjected to this system and may be automatically rejected according to a set of rules. This study aimed: (1) to identify the number of chemistry tests rejected by the eGK; (2) to identify which of these rejected tests were subsequently restored and (3) to assess the impact of rejections on clinical outcome and cost-saving. Methods: A retrospective audit was conducted to determine the number of chemistry tests rejected and subsequently restored over a 6-month period. The case-notes of patients for whom requested tests previously rejected had been restored were randomly selected and investigated to assess clinical impact. Any cost-saving was calculated. Results: A total of 68,480 tests were subjected to gate-keeping, and 4605 tests (6.7%) were rejected while 679 (14.7%) of these were restored by the requestor phoning the laboratory after obtaining authorisation. After examining a subset of clinical notes it was found that in most cases (80%), patient care was unaffected. The total cost saved was £25,387. Conclusions: The majority of the rejected tests were unnecessary and following rejection, real savings were made. Electronic gate-keeping is a simple, effective and sustainable method of demand management.

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A Utilization Management Intervention to Reduce Unnecessary Testing in the Coronary Care Unit

Abstract: The utilization management intervention was associated with significant reductions in test ordering without a measurable change in clinical outcomes.

Cited by 103 publications

References 15 publications

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Efficiency of test report delivery to the requesting physician in an outpatient setting: an observational study

Demand management: an audit of chemical pathology test rejections by an electronic gate-keeping system at an academic hospital in Cape Town

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