Reducing inappropriate ESR testing with computerized clinical decision support

Gottheil, Stephanie; Khemani, Ekta; Copley, Katherine; Keeney, Michael; Kinney, Jeff; Chin‐Yee, Ian; Gob, Alan

doi:10.1136/bmjquality.u211376.w4582

Cited by 25 publications

(17 citation statements)

References 19 publications

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“…Overall, 81.2% of the included studies were published after 2010 and, of these, 69.2% were published after 2015. Most of the included studies were conducted in the United States (n = 12, 75%); and one was conducted in each of the following countries: Canada [30], United Kingdom [31], Italy [32], and France [33]. Table 1) Characteristics of the included studies…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

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Laboratory Test Ordering in Inpatient Hospitals: A Scoping Review on the Effects and Features of Clinical Decision Support Systems

Zare

Meidani

Shirdeli

et al. 2020

Preprint

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Background: Studies have revealed inappropriate laboratory testing as a source of waste. This review was aimed to evaluate the effects and features of CDSSs on physicians' appropriate laboratory test ordering in inpatient hospitals.Method: Medline through PubMed, SCOPUS, Web of Science, and Cochrane were queried without any time period restriction. The outcomes were categorized based on test-related, physician-related, and patient-related. The primary outcome measures were the number and cost of laboratory test ordered.Result: Sixteen studies met the inclusion criteria. Most studies were conducted based on a quasi-experimental design. The results showed improvement in laboratory test-related outcomes (e.g. proportion and cost of tests) and also physician-related outcomes (e.g. guideline adherence and orders cancellation). Patient-related outcomes (e.g. length of stay and mortality rate) were not well investigated in the included studies. Also, the evidence about applying CDSS as a decision aid for interpreting laboratory results was rare.Conclusion: CDSSs increase appropriate test ordering in hospitals through eliminating redundant test orders and enhancing evidence-based practice. Appropriate testing and cost saving were both affected by the CDSSs. However the evidence is limited about the effects of laboratory test CDSSs on patient-related outcomes.

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Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…This may have caused an unintentional prompt to order these tests together without original plan. Decreasing cost of tests was approved in several studies [28,30,32,34,37,38,41]. But it is important to mention that quality of the studies were fair and results were not analyzed statistically.…”

Section: Laboratory Test-related Outcomesmentioning

confidence: 99%

Laboratory Test Ordering in Inpatient Hospitals: A Scoping Review on the Effects and Features of Clinical Decision Support Systems

Zare

Meidani

Shirdeli

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…For example, implementation of an order set for erythrocyte sedimentation rate (ESR) testing, which required inputting a clinical indication, reduced ESR orders by 40%. 24 In another study, making serotonin release assays (SRA) only available as a reflex test after a positive HIT ELISA was associated with reduced SRA orders. 18 In some cases, however, inappropriate grouping of tests may lead to overutilization, as described in a study of an order set for workup of anemia that included vitamin B12, folate, and ferritin.…”

Section: Implementation Of Mandatory Venous Thromboembolism (Vte)mentioning

confidence: 99%

“…Finally, in conjunction with other CDS tools, regulating order sets and test menus can reduce unnecessary hematology laboratory testing. For example, implementation of an order set for erythrocyte sedimentation rate (ESR) testing, which required inputting a clinical indication, reduced ESR orders by 40% . In another study, making serotonin release assays (SRA) only available as a reflex test after a positive HIT ELISA was associated with reduced SRA orders …”

Section: Applications Of Cds In Hematology and Coagulation Testingmentioning

confidence: 99%

Clinical decision support for hematology laboratory test utilization

Jackups

Szymanski

Persaud

2017

Int J Lab Hematology

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Clinical decision support (CDS) is the use of information and communication technologies to improve clinical decision making and patient care. CDS applications have been used in many aspects of health care, including medication ordering and diagnostic prediction algorithms. As economic and regulatory pressures place a strain on laboratory resources, the potential of CDS to improve utilization of laboratory testing has also begun to be realized. Hematology and coagulation laboratories stand to gain tremendously from the implementation of CDS interventions, given their mixture of highvolume, low-cost tests (eg CBC, PT, aPTT) and tests that carry a high potential of being misused or misinterpreted (eg lupus anticoagulant, erythrocyte sedimentation rate, heparin-induced thrombocytopenia testing). This brief review will define the key terms in the field of clinical decision support, provide instructive examples of CDS interventions to improve utilization of hematology and coagulation testing, introduce methods to implement these interventions effectively, and discuss metrics by which the success of these interventions can be evaluated. K E Y W O R D Scomputers, education, healthcare costs, laboratory practice, laboratory utilization

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“…6 Health care systems increasingly utilize clinical decision support (CDS) to modify provider-ordering behavior and to assist in reducing the use of expensive treatment and diagnostic choices. 7 CDS has been shown to successfully lower inappropriate Clostridium difficile testing, 8 erythrocyte sedimentation rate assessments, 9 unnecessary imaging studies, 10 and duplicate laboratory testing. 11 CDS can reduce errors in order placement 12 and increase compliance with laboratory testing recommendations.…”

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confidence: 99%

Is the Climb Worth the View? The Savings/Alert Ratio for Reducing Vitamin D Testing

et al. 2020

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Background Despite guideline recommendations, vitamin D testing has increased substantially. Clinical decision support (CDS) presents an opportunity to reduce inappropriate laboratory testing. Objectives and Methods To reduce inappropriate testing of vitamin D at the Vanderbilt University Medical Center, a CDS assigned providers to receive or not receive an electronic alert each time a 25-hydroxyvitamin D assay was ordered for an adult patient unless the order was associated with a diagnosis in the patient's chart for which vitamin D testing is recommended. The CDS ran for 80 days, collecting data on number of tests, provider information, and basic patient demographics. Results During the 80 days, providers placed 12,368 orders for 25-hydroxyvitamin D. The intervention group ordered a vitamin D assay and received the alert for potentially inappropriate testing 2,181 times and completed the 25-hydroxyvitamin D order in 89.9% of encounters, while the control group ordered a vitamin D assay (without receiving an alert) 2,032 times and completed the order in 98.1% of encounters, for an absolute reduction of testing of 8% (p < 0.001). Conclusion This CDS reduced vitamin D ordering by utilizing a soft-stop approach. At a charge of $179.00 per test and a cost to the laboratory of $4.20 per test, each display of the alert led to an average reduction of $14.70 in charges and of $0.34 in spending by the laboratory (the savings/alert ratio). By describing the effectiveness of an electronic alert in terms of the savings/alert ratio, the impact of this intervention can be better appreciated and compared with other interventions.

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Reducing inappropriate ESR testing with computerized clinical decision support

Cited by 25 publications

References 19 publications

Laboratory Test Ordering in Inpatient Hospitals: A Scoping Review on the Effects and Features of Clinical Decision Support Systems

Laboratory Test Ordering in Inpatient Hospitals: A Scoping Review on the Effects and Features of Clinical Decision Support Systems

Clinical decision support for hematology laboratory test utilization

Is the Climb Worth the View? The Savings/Alert Ratio for Reducing Vitamin D Testing

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