Embedding Time-Limited Laboratory Orders Within Computerized Provider Order Entry Reduces Laboratory Utilization*

Abstract

Limits on laboratory orders within the context of computerized provider order entry decreased laboratory utilization without adverse affects on mortality or length of stay. Broader application of this strategy might decrease costs, the incidence of iatrogenic anemia, and catheter-associated bloodstream infections.

Elimination of clinical biochemistry laboratory tests through artificial intelligence programs to increase cost-effectiveness

“…Controlling ordering frequency is another proposed method. In one study of intensive care unit patients, the ordering of complete blood counts, biochemistries, and coagulation tests more than once in a 24-hour period was blocked, and this was reported to reduce order numbers without causing any side effects or affecting discharge times [31]. Relentless strategies, such as blocking laboratory tests at the time of order, are undesirable because they restrict the clinicians' freedom and may lead to concerns that conditions may not be diagnosed in time.…”

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

“…These tools have been shown to align provider ordering with current best practices, promote cost-effectiveness, and ultimately improve patient care quality. [17][18][19][20][21][22][23][24][25][26] The objective of this report is to describe the impact of this initiative on laboratory resource utilization and the cost of inpatient care as well as to examine possible unintended consequences of this initiative.…”

“…[5][6][7][8][9][10][11][12] Variability in practice, fear of litigation, and unchecked standing orders are described as the leading reasons for excessive utilization of healthcare resources. 6,24,34 Although there are reports of quality initiatives with the purpose of targeting laboratory overutilization, the data on the impact these initiatives have on health care cost is scarce. We present a quality initiative in our center that resulted in decreased laboratory utilization for several routine tests.…”

Use of Electronic Medical Record–Enhanced Checklist and Electronic Dashboard to Decrease CLABSIs

“…34 Previous reports from our group offer additional support for the notion that computerized interventions in the PICU improved compliance with blood transfusion guidelines 15 and reduced unnecessary laboratory use. 16 As the number of evidence-based patient safety interventions continues to climb, 10 a significant burden is placed on health care professionals to ensure compliance with all measures to prevent patient harm. 11 In fact, a previous effort to integrate paper checklists into PICU rounds at our own institution, though temporarily successful, proved unsustainable because of the additional work burden imposed on providers.…”

“…11 To effectively address all the potential sources of patient harm, systems of care must be developed to standardize care, improve communication, and promote timely access to information at the point of care. [12][13][14][15][16] The electronic medical record (EMR), with integrated nursing documentation, computerized physician order entry, and clinical decision support, has the potential to facilitate achievement of these goals. 14,17 With thoughtful design and implementation, these tools can be used to automate practices and highlight compliance with interventions via continuously updated visual displays that extract the most up-to-date information directly from the EMR.…”