Targeting blood tests in the ICU may lead to a significant cost reduction

Gray, R.; Baldwin, F

doi:10.1186/cc13205

Cited by 5 publications

(5 citation statements)

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“…1 ). Twenty-two studies were only available as conference abstracts (26–30, 33, 50, 51, 55, 58, 65–69, 72, 73, 75, 78, 81, 82, 87). The main reasons for full-text exclusions were ineligible topic ( n = 81), ineligible population ( n = 58), no original data ( n = 55), and ineligible intervention ( n = 23).…”

Section: Resultsmentioning

confidence: 99%

“…We included a total of 81 records representing 70 studies: 50 nonrandomized interventional studies (19–68) and 20 observational studies (69–88) ( Fig. 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…Thirty-seven out of the 50 (74%) included nonrandomized interventional studies (20, 22–26, 28, 30, 31, 34, 37–53, 55, 57–62, 66, 67) and 13 out of the 20 (65%) included observational studies (69–73, 75–78, 80, 82, 83, 86) reported resource utilization-centered outcome measures. Estimated annual cost reductions were reported in 34 of 50 (68%) nonrandomized interventional studies (20, 23–26, 30, 31, 34, 37–53, 55, 57–62, 66, 67); variations were substantial in the reported estimates.…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Routine Versus On-Demand Blood Sampling in Critically Ill Patients: A Systematic Review*

Hjortsø

Møller

Perner

et al. 2023

Critical Care Medicine

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OBJECTIVES: We aimed to provide an overview of the current evidence on routine versus on-demand blood sampling in critical care. We assessed the reported proportion of patients exposed to daily routine blood sampling, the tests performed, characteristics associated with more frequent blood sampling, and the reported benefits and harms of routine blood sampling compared with on-demand sampling. DATA SOURCES: We systematically searched the Cochrane Library, the Excerpta Medica Database, and the Medical Literature Analysis and Retrieval System Online for studies assessing routine versus on-demand blood testing in critically ill patients from inception to September 2022. STUDY SELECTION: Abstracts and full texts were assessed independently and in duplicate by two reviewers. STUDY EXTRACTION: Data were extracted independently and in duplicate by two reviewers using predefined extraction forms. DATA SYNTHESIS: Of 12,212 records screened, 298 full-text articles were assessed for eligibility. We included 70 studies; 50 nonrandomized interventional studies and 20 observational studies. Exposure to routine blood testing was 52–100% (very low certainty of evidence). Blood testing seemed to occur more frequently in medical intensive care settings with a median of 18 blood tests per patient day (interquartile range, 10–33) (very low certainty of evidence). Mixed biochemistry seemed to be the most frequently performed blood tests across all settings (five tests per patient day; interquartile range, 2–10) (very low certainty of evidence). Reductions in routine blood testing seemed to be associated with reduced transfusion rates and costs without apparent adverse patient outcomes (low certainty of evidence). CONCLUSIONS: In this systematic review, routine blood testing in critically ill patients was common and varied considerably. A reduction in routine blood testing appeared to be associated with reduced transfusion rates and costs without adverse effects, but the evidence was very uncertain.

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Section: Resultsmentioning

confidence: 99%

“…We included a total of 81 records representing 70 studies: 50 nonrandomized interventional studies (19–68) and 20 observational studies (69–88) ( Fig. 1 ).…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Routine Versus On-Demand Blood Sampling in Critically Ill Patients: A Systematic Review*

Hjortsø

Møller

Perner

et al. 2023

Critical Care Medicine

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“…Although conventional blood gas sampling methods are considered as "gold standard", there is always place for a less invasive, painless, and timesaving "patientfriendly" alternatives. There are many papers implicating the cons of unnecessary blood draws with respect to not only anemia but also infection control and healthcare costs (6,7). Therefore the need for less invasive monitoring methods is evident.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Transcutaneous and Arterial Blood Gas Analyses in Patients with Sepsis and Septic Shock

Saruhan¹,

Uğur²,

Ganidagli³

et al. 2021

tybd

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Objective: This study aims to compare the effectiveness of non-invasive pressure of transcutaneous CO 2 (PtcCO 2 ) and O 2 (PtcO 2 ) analyzers versus conventional blood gas sampling in patients with sepsis and septic shock. Materials and Methods: Sepsis patients without a need for inotrope support (sepsis) were prospectively enrolled to group 1 (n=50), whereas group 2 (n=50) was composed of patients needing inotropes (septic shock). Demographic data, laboratory tests, Acute Physiology and Chronic Health Evaluation-II (APACHE-II) and Sequential Organ Failure Assessment (SOFA) scores, standard monitoring data, data of blood gas analysis (pH, PaCO 2 , PaO 2 , and SaO 2 ), and transcutaneous CO 2 and O 2 were collected at the first, second, third, and fourth hours. Results: No significant difference was noted between the groups in terms of demographic parameters, baseline white blood cell, hematocrit, baseline heart rate, central venous pressure, respiratory rate, and positive end-expiratory pressure values. Group 2 had significantly higher serum urea and creatinine levels and lower albumin levels and mean arterial pressure, whereas group 1 had significantly lower APACHE-II and SOFA scores and peak inspiratory pressure and FiO 2 . No significant difference was noted between the PtcCO 2 and PaCO 2 values in group 1, whereas the PtcCO 2 values of group 2 were significantly lower than PaCO 2 . PtcO 2 and PaO 2 values were significantly lower in group 1, whereas PtcO 2 vs PaO 2 values were significantly lower in group 2. A strong correlation was noted between arterial and transcutaneous CO 2 and O 2 values in both the groups. Conclusion: PtcCO 2 assessment may be an alternative method in patients with sepsis but not in septic shock. PtcO 2 measurement may not be a reliable method for patients with sepsis and septic shock. Keywords: Sepsis, septic shock, ICU, transcutaneous CO 2 , transcutaneous O 2 , arterial blood gas analysis ÖZ Amaç: Sepsisli ve septik şoklu hastalarda non-invaziv transkutanöz parsiyel CO 2 (PtcCO 2 ) ve O 2 (PtcO 2 ) basıncı analizörlerininin etkinliğini geleneksel kan arter kan gazı analizi ile karşılaştırmayı amaçladık. Gereç ve Yöntem: Sepsis 3 tanı kriterlerine göre "sepsis" tanısı alan hastalar grup 1'e (n=50), "septik şok" tanısı alan hastalar grup 2'ye (n=50) ayrıldı. Demografik veriler, laboratuvar testleri, Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi-II (APACHE-II) ve Ardışık Organ Yetersizliği Değerlendirme (SOFA) skorları, 1., 2., 3., ve 4. saatlerdeki standart monitorizasyon verileri, kan gazı analizi verileri (pH, PaCO 2 , PaO 2 , SaO 2 ) ve transkutanöz CO 2 ve O 2 değerleri kaydedildi. Bulgular: Gruplar arasında demografik parametreler, başlangıç beyaz küre, hematokrit, kalp hızı, santral venöz basınç, solunum sayısı ve pozitif ekspirasyon-sonu basınç değerleri açısından anlamlı bir fark bulunamadı. Grup 2'de serum üre ve kreatinin seviyeleri belirgin olarak yüksekken, albümin seviyeleri, ortalama arteriyel basınç daha düşüktü. APACHE-II ve SOFA skorları, tepe inspiratuar basınç ve...

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“… 6-bed FBC; CHEM (BUN, electrolytes, LFT, CA, P, ALB, CRP); COAG ( n.o.s. ) A&F (audit of personnel via order chart) Pre-I: 100 days Post-I: 100 days 33% total reduction (COAG 52%, LFT 54%, BP 54%) GBP ~ 3000 per bed N/S Gray & Baldwin [ 137 ] 2014 Prospective BAA (C.A.) 26-bed FBC; CHEM (BUN, electrolytes, LFT, CRP, BP, MG); COAG ( n.o.s. )…”

Section: Interventions To Improve Laboratory Testing Appropriateness ...mentioning

confidence: 99%

Interventions to improve appropriateness of laboratory testing in the intensive care unit: a narrative review

Devis,

Catry,

Honore

et al. 2024

Ann. Intensive Care

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Healthcare expenses are increasing, as is the utilization of laboratory resources. Despite this, between 20% and 40% of requested tests are deemed inappropriate. Improper use of laboratory resources leads to unwanted consequences such as hospital-acquired anemia, infections, increased costs, staff workload and patient stress and discomfort. The most unfavorable consequences result from unnecessary follow-up tests and treatments (overuse) and missed or delayed diagnoses (underuse). In this context, several interventions have been carried out to improve the appropriateness of laboratory testing. To date, there have been few published assessments of interventions specific to the intensive care unit. We reviewed the literature for interventions implemented in the ICU to improve the appropriateness of laboratory testing. We searched literature from 2008 to 2023 in PubMed, Embase, Scopus, and Google Scholar databases between April and June 2023. Five intervention categories were identified: education and guidance (E&G), audit and feedback, gatekeeping, computerized physician order entry (including reshaping of ordering panels), and multifaceted interventions (MFI). We included a sixth category exploring the potential role of artificial intelligence and machine learning (AI/ML)-based assisting tools in such interventions. E&G-based interventions and MFI are the most frequently used approaches. MFI is the most effective type of intervention, and shows the strongest persistence of effect over time. AI/ML-based tools may offer valuable assistance to the improvement of appropriate laboratory testing in the near future. Patient safety outcomes are not impaired by interventions to reduce inappropriate testing. The literature focuses mainly on reducing overuse of laboratory tests, with only one intervention mentioning underuse. We highlight an overall poor quality of methodological design and reporting and argue for standardization of intervention methods. Collaboration between clinicians and laboratory staff is key to improve appropriate laboratory utilization. This article offers practical guidance for optimizing the effectiveness of an intervention protocol designed to limit inappropriate use of laboratory resources.

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Targeting blood tests in the ICU may lead to a significant cost reduction

Cited by 5 publications

References 1 publication

Routine Versus On-Demand Blood Sampling in Critically Ill Patients: A Systematic Review*

Routine Versus On-Demand Blood Sampling in Critically Ill Patients: A Systematic Review*

Comparison of Transcutaneous and Arterial Blood Gas Analyses in Patients with Sepsis and Septic Shock

Interventions to improve appropriateness of laboratory testing in the intensive care unit: a narrative review

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