Duplicate Laboratory Test Reduction Using a Clinical Decision Support Tool

Abstract

The movement to CPOE affords real-time interaction between the laboratory and the physician through CDSTs that signal duplicate orders. These interactions save health care dollars and should also increase patient satisfaction and well-being.

Computer-based-limited and personalised education management maximise appropriateness of vitamin D, vitamin B12 and folate retesting

“…For all vitamins we showed that a moderate-strength strategy reduced inappropriate retesting but its efficacy was limited: only a 7% increase in appropriate retesting for vitamin D and vitamin B12, and a 5% increase for folate. This indicates that ‘pop-up window fatigue’ does not enhance appropriateness, as observed by Procop et al 26 27 in their study on duplicate testing. A more stringent computer-based strategy effectively increased the percentage of appropriate vitamin D retesting among inpatients (64% in the limiting period with respect to 40% reference), and limited the increasing trend in the total number of patients for retesting (see figure 2A), which parallels the overall increase in vitamin D orders 15.…”

Implementation of a Clinical Decision Support Tool for Stool Cultures and Parasitological Studies in Hospitalized Patients

“…Best practice dictates that providers should be contacted in a timely manner and informed that their test will not be performed; they should also be given the opportunity to discuss the clinical circumstances and, if the clinical scenario is supportive, to proceed with the order. The ability to both stop unnecessary testing and afford the provider the opportunity to override the electronic blockage using CDSTs has been described and implemented at our institution for stopping same-day duplicate orders and expensive molecular genetic tests (13)(14)(15). Therefore, we developed a CDST that would electronically assess the days of hospitalization and stop stool cultures and parasitologic examations for patients who had been hospitalized for more than 3 days.…”

Reducing Duplicate Testing

“…To address this type of overuse, we devised and implemented a clinical decision support tool (CDST) (i.e., the Hard Stop alert) that would block tests that were deemed to be unnecessary more than once per day in clinical practice. 5 We implemented processes within our system whereby the ordering physician could obtain the blocked test if he or she decided it was clinically necessary. To obtain the blocked test, the provider was instructed to contact our client service section of the laboratory for instructions regarding how to obtain the desired test.…”

“…We have recently reported the effectiveness and cost savings associated with this type of intervention. 5 Although the Hard Stop CDST has proven highly effective in our primary hospital (ie, the main campus of Cleveland Clinic), for a variety of reasons, it was not thought to be the best CDST for the hospitals in our regional practice (see Discussion). We wanted, however, to share the successes of such an intervention with our colleagues in the regional practices, so we devised an alternate CDST for use in these settings (ie, the Smart Alert).…”