A Written Guideline Implementation Can Lead to Reductions in Laboratory Testing in an Intensive Care Unit

Abstract

The impact of developing guidelines for laboratory testing in an Intensive Care Unit (ICU) was examined. Targeted blood tests were recorded on fifty cardiac surgery and fifty general intensive care patients retrospectively. Following the introduction of guidelines, the study was repeated with prospective data collection. Comparison of the samples before and after the intervention showed a 25.9% reduction in all blood tests and a 17.1% reduction in arterial blood gases in the post cardiac surgery group. In general ICU patients, the drop in all tests was 16.6% and in arterial blood gases 21.9%. The cost savings from the cardiac surgery sample was N.Z.$3,637 and general ICU N.Z.$3,166, giving a sum total of N.Z.$6,803 in 100 patients. The potential cost savings for the annual admissions of 1,200 patients is N.Z.$81,636. This study shows that written guidelines can bring about major cost reduction in the short-term.

The use of a blood conservation pressure transducer system in critically ill patients

“…No attempt was made to quantify the number of laboratory investigations performed on our patients. Previous studies have shown that the development of practice guidelines for arterial blood gas measurement and laboratory testing both decrease the number of blood tests carried out [11,12]. There is also evidence that more blood tests are ordered in ICUs in university teaching hospitals than in other ICUs [13].…”

A Written Policy Increases Compliance With Guidelines for Therapeutic Anticoagulation Prior to Elective Direct Current Cardioversion of Atrial Fibrillation

“…There is little published data on the use of written policies based on clinical guidelines in terms of impact on adherence to such guidelines and clinical outcomes. Written policies have been noted in the literature in diverse areas including laboratory testing, 18 central line management, 19 HIV, 20 do-not-resuscitate orders, 21 and vaccinations. 22 The presence of a written policy facilitates the ability of nonphysician providers, in our case, the nurse, to maintain appropriate standards of quality care in a nonconfrontational way, which is in the patient's best interest.…”

Avaliação da necessidade da solicitação de exames complementares para pacientes internados em unidade de terapia intensiva de hospital universitário

“…Em segundo lugar encontra-se a dificuldade em avaliar o custo real da realização dos exames a que se destina o estudo, já que não foram computados os valores referentes aos tubos de coleta, seringas e demais materiais necessários para a sua execução e para a análise do sangue coletado. Quanto às implicações deste trabalho para a prática clínica e pesquisa científica, o conhecimento de que o número excessivo de exames pode levar a custos desnecessários e a possíveis repercussões clínicas, poderá justificar a possível reflexão a respeito da adoção de parâmetros que objetivem a restrição de solicitação destes exames 13,15 .…”

“…Os exames quantificados foram aqueles que mais comumente são solicitados em UTI: sódio, potássio, cálcio, fósforo, magnésio, creatinina e uréia séricos, tempo de protrombina (TAP), tempo de tromboplastina parcial ativada (TTPA), ácido lático, gasometria arterial, glicemia capilar, glicemia de jejum, hemograma e plaquetas. Para análise estatística os pacientes foram divididos obedecendo três critérios: faixa etária (menor ou igual e maior que 60 anos), desfecho de saída da UTI (alta ou óbito), e gravidade (índice APACHE II, tendo como ponto de corte 50%) 13 . As variáveis contínuas foram analisadas com o uso do teste de Análise de Variância (ANOVA) e para avaliar proporções utilizou-se, quando necessário, os testes Qui-quadrado e Exato de Fisher, sendo considerado significativo quando p < 0,05.…”