Impact of an electronic decision support rule on ESR/CRP co-ordering rates in a community health system and projected impact in the tertiary care setting and a commercially insured population

Juskewitch, Justin E.; Norgan, Andrew P.; Johnson, Reid C.; Trivedi, Vipul A.; Hanson, Curtis A.; Block, Darci R.

doi:10.1016/j.clinbiochem.2019.01.009

Cited by 5 publications

(4 citation statements)

References 12 publications

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“…Coupled with the lack of diagnostic accuracy, CRP should be ordered instead of ESR in routine practice, and CRP and ESR should not be ordered together. 30…”

Section: Rationalementioning

confidence: 99%

Reduce, Reuse, Recycle: Top 10 Choosing Wisely Canada’s Recommendations for Conserving Laboratory Resources

Beriault

Rodríguez-Capote

Hauff

et al. 2022

Can Journ Gen Int Med

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The COVID-19 pandemic has significantly impacted the production, distribution, and demand of essential laboratory supplies worldwide. In 2021, severe shortages in required laboratory supplies such as blood collection tubes, butterfly needles, and blood gas syringes became a critical issue across Canada. Many hospitals or institutions had to instruct physicians and patients to limit laboratory testing where possible and, in some cases, required emergency shipments of tubes from alternative vendors or nearby hospitals. Laboratory testing is ubiquitous in managing patients. It is used for screening, diagnosis, and monitoring purposes. With limited blood collection tubes, consideration for restricting non-urgent testing is needed to conserve supply and protect acute care departments that manage critically ill patients. In addition, laboratories across Canada have experienced significant staffing shortages, resulting in an even greater need for appropriate laboratory utilization. Consequently, the Canadian Society of Clinical Chemists (CSCC) and the Canadian Association of Medical Biochemists (CAMB) curated utilization recommendations for both hospital and primary care settings in collaboration with Choosing Wisely Canada (CWC). These recommendations were specifically selected from those previously published by Choosing Wisely Canada (CWC), with impact statements and rationales added to conserve at-risk laboratory resources. Supply chain disruptions of clinical laboratory resources are expected to continue throughout 2022, indicating that now, more than ever, a focus on appropriate laboratory utilization is essential. RésuméLa pandémie de COVID-19 a eu un impact considérable sur la production, la distribution et la demande de fournitures de laboratoire essentielles dans le monde entier. À partir de 2021, de graves pénuries de fournitures de laboratoire essentielles, comme les tubes pour prélèvement sanguin, les aiguilles à ailettes et les seringues pour l’analyse de gaz sanguin, sont devenues un question cruciale au Canada. De nombreux hôpitaux et étab-lissements ont dû demander aux médecins et aux patients de limiter dans la mesure du possible les analyses en laboratoire et, dans certains cas, ont eu besoin qu’on leur envoie d’urgence des tubes provenant d’autres fournis-seurs ou d’hôpitaux voisins. Les analyses en laboratoire sont omniprésentes dans la prise en charge des patients et sont utilisées à des fins de dépistage, de diagnostic et de suivi. Étant donné le nombre limité de tubes pour prélèvement sanguin, il faut envisager de restreindre les analyses non urgentes pour conserver les réserves et protéger les services de soins de courte durée qui prennent en charge les patients gravement malades. De plus, partout au Canada, les laboratoires connaissent des pénuries importantes de personnel, ce qui rend encore plus nécessaire une utilisation appropriée des laboratoires. Par conséquent, la Société canadienne des clini-co-chimistes (SCCC) et l’Association des médecins biochimistes du Canada (CAMB), en collaboration avec Choisir avec soin (CAS), ont préparé des recommandations d’utilisation pour les milieux hospitaliers et de soins de santé primaires. Ces recommandations ont été spécifiquement choisies à partir de celles déjà publiées par CAS, en y ajoutant des énoncés des répercussions et des justifications, et visent à conserver les ressources de laboratoire à risque. On s’attend à ce que les perturbations de la chaîne d’approvisionnement en ressources de laboratoire clinique se poursuivent tout au long de l’année 2022, ce qui indique que maintenant, plus que jamais, il est essentiel de se concentrer sur une utilisation appropriée des laboratoires.

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“…Coupled with the lack of diagnostic accuracy, CRP should be ordered instead of ESR in routine practice, and CRP and ESR should not be ordered together. 30…”

Section: Rationalementioning

confidence: 99%

Reduce, Reuse, Recycle: Top 10 Choosing Wisely Canada’s Recommendations for Conserving Laboratory Resources

Beriault

Rodríguez-Capote

Hauff

et al. 2022

Can Journ Gen Int Med

View full text Add to dashboard Cite

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“…Similarly, Juskewitch et al [ 16 ] implemented an alert, triggered by the concomitant order of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in a community health system. Again, the user is informed about the inappropriate request and has the choice to cancel ESR or to proceed with the order.…”

Section: Possible Strategies To Avoid Inappropriate Test Utilizationmentioning

confidence: 99%

“…Only a minority of surveyed clinicians stated that cost information frequently influenced their decisions. In general, cost control is endorsed by clinicians, but reductions in expenditure may be also achieved by implementing DM strategies, which combat overutilization [ 14 , 16 , 17 , 19 , 21 , 26 , 28 , 29 , 30 , 31 ].…”

Section: Possible Strategies To Avoid Inappropriate Test Utilizationmentioning

confidence: 99%

“…Lack of knowledge, insecurity, pure habit, patient pressure or fear of lawsuits are possible causes for inappropriate testing [ 13 , 14 , 15 ]. The lack of knowledge is reflected by various studies, which observed inappropriate orders despite available guidelines or recommendations on the implementation of demand management (DM) tools [ 12 , 14 , 16 , 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

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Laboratory Demand Management Strategies—An Overview

et al. 2021

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Inappropriate laboratory test selection in the form of overutilization as well as underutilization frequently occurs despite available guidelines. There is broad approval among laboratory specialists as well as clinicians that demand management strategies are useful tools to avoid this issue. Most of these tools are based on automated algorithms or other types of machine learning. This review summarizes the available demand management strategies that may be adopted to local settings. We believe that artificial intelligence may help to further improve these available tools.

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Reducing Inappropriate Simultaneous Ordering of Heparin Antibody and Serotonin Release Assays

Talledo¹,

Cho²,

Alaiev³

et al. 2023

The Joint Commission Journal on Quality and Patient Safety

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Impact of an electronic decision support rule on ESR/CRP co-ordering rates in a community health system and projected impact in the tertiary care setting and a commercially insured population

Cited by 5 publications

References 12 publications

Reduce, Reuse, Recycle: Top 10 Choosing Wisely Canada’s Recommendations for Conserving Laboratory Resources

Reduce, Reuse, Recycle: Top 10 Choosing Wisely Canada’s Recommendations for Conserving Laboratory Resources

Laboratory Demand Management Strategies—An Overview

Reducing Inappropriate Simultaneous Ordering of Heparin Antibody and Serotonin Release Assays

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