Diagnostic blood loss in mechanically ventilated patients

Shaffer, Carol

doi:10.1016/j.hrtlng.2006.09.001

Cited by 27 publications

(21 citation statements)

References 16 publications

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“…In a community hospital setting, Shaffer [12] examined the amount of blood loss due to laboratory testing in critically ill ventilated patients. The average cumulative phlebotomy volume was 57 to 1,120 mL per patient.…”

Section: Phlebotomy Volumementioning

confidence: 99%

Contemporary Bloodletting in Cardiac Surgical Care

Koch

Reineks

Tang

et al. 2015

The Annals of Thoracic Surgery

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Section: Phlebotomy Volumementioning

confidence: 99%

Contemporary Bloodletting in Cardiac Surgical Care

Koch

Reineks

Tang

et al. 2015

The Annals of Thoracic Surgery

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“…[6][7][8][9][10] Multiple reports suggest that an important percentage of diagnostic studies may be medically unnecessary, redundant, and contribute to potential harm. 3,[11][12][13][14][15][16] We recognized that laboratory testing was susceptible to high utilization in our pediatric cardiovascular ICU (CVICU), where testing may be ordered daily or more frequently without strong clinical justification. To address this potential overutilization, we implemented a CVICU-based initiative consisting of a paper-based "daily checklist" and clinical decision support tool embedded within computerized order entry (CPOE).…”

Section: Discussionmentioning

confidence: 99%

Use of a Checklist and Clinical Decision Support Tool Reduces Laboratory Use and Improves Cost

Algaze¹,

Wood²,

Pageler

et al. 2016

Pediatrics

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The cost of health care in the United States ($8,745 annual per capita in 2012) is the highest in the world. 1 Despite a high percentage of the US Gross Domestic Product consumed by health care, as a nation we are not benefitting from improved health. As high-use environments, ICUs contribute significantly to this high cost, with an estimated consumption of 20% to 30% of all health care expenditures. 2 In response, the Institute for Health Care Improvement has conveyed that quality improvement efforts must consider control of health care expenditures. 3 Apart from expensive innovative technologies, an important component of health care spending is the high utilization of low-cost services such as laboratory tests and radiographs. 4,5 Studies have shown high variability in the intensity of these services provided to similar patients among major US academic medical centers. 6-10 These practices are not necessarily guided by published practice guidelines abstract OBJECTIVE: We hypothesized that a daily rounding checklist and a computerized order entry (CPOE) rule that limited the scheduling of complete blood cell counts and chemistry and coagulation panels to a 24-hour interval would reduce laboratory utilization and associated costs. METHODS:We performed a retrospective analysis of these initiatives in a pediatric cardiovascular ICU (CVICU) that included all patients with congenital or acquired heart disease admitted to the cardiovascular ICU from September 1, 2008, until April 1, 2011. Our primary outcomes were the number of laboratory orders and cost of laboratory orders. Our secondary outcomes were mortality and CVICU and hospital length of stay. RESULTS:We found a reduction in laboratory utilization frequency in the checklist intervention period and additional reduction in the CPOE intervention period [complete blood count: 31% and 44% (P < .0001); comprehensive chemistry panel: 48% and 72% (P < .0001); coagulation panel: 26% and 55% (P < .0001); point of care blood gas: 43% and 44% (P < .0001)] compared with the preintervention period. Projected yearly cost reduction was $717, 538.8. There was no change in adjusted mortality rate (odds ratio 1.1, 95% confidence interval 0.7-1.9, P = .65). CVICU and total length of stay (days) was similar in the pre-and postintervention periods. CONCLUSIONS:Use of a daily checklist and CPOE rule reduced laboratory resource utilization and cost without adversely affecting adjusted mortality or length of stay. CPOE has the potential to hardwire resource management interventions to augment and sustain the daily checklist.

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“…Each were reviewed and assessed for content and incorporation of seven evidence-based blood conservation strategies which are recommended in peer-reviewed literature. 1,4,6,12 These strategies were: frequent evaluation by clinicians of routine blood sampling orders, closed-system sampling, small-volume phlebotomy tubes, non-invasive monitoring, bundled scheduling of blood sampling, charting of cumulative daily phlebotomy loss and point of care testing. 1,4,6,12…”

Section: Blood Conservation Cpgmentioning

confidence: 99%

“…1,2,6,12 The described daily average blood sampling volumes varied depending upon the population studied, the length of stay evaluated and the methodology of the study; with the highest volumes commonly occurring in the immediate post-operative period. 1,2,6,12 Just over a decade ago, seminal work by Vincent et al, 2 and Corwin et al, 3 described the challenges associated with blood conservation practices throughout ICUs and the resulting overprescription of packed red blood cell (PRBC) transfusions. Current evidence suggests that PRBC transfusions are associated with infectious and inflammatory complications, significant financial costs, worse clinical outcomes and transfusion errors.…”

Section: Introductionmentioning

confidence: 99%

“…end tidal carbon dioxide [ETCO 2 ], oxygen saturations [SpO 2 ]), bundled scheduling of blood tests to minimise loss of 'clearing' volume, routine charting of cumulative daily phlebotomy blood loss, and point of care bedside microanalysis. 1,4,6,12 Randomised controlled studies and clinical controlled trials have been undertaken surrounding the efficacy of individual conservation strategies to prevent and/or treat the associated anaemia, including the use of small-volume phlebotomy tubes, 14 closed-system sampling enabling safe discard return 5,15-18 and a combined approach. 4,19 Other strategies commonly advocated in clinical settings, such as point of care bedside microanalysis, have less rigorous observational studies to support their use.…”

Section: Introductionmentioning

confidence: 99%

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