Implementation of Clinical Decision Support Rules to Reduce Repeat Measurement of Serum Ionized Calcium, Serum Magnesium, and N-Terminal Pro-B-Type Natriuretic Peptide in Intensive Care Unit Inpatients

Moyer, Ann M.; Saenger, Amy K.; Willrich, Maria Alice V.; Donato, Leslie J.; Baumann, N; Block, Darci R.; Botz, Chad M.; Khan, Munawwar Ali; Jaffe, Allan S.; Hanson, Curtis A.; Karon, Brad S.

doi:10.1373/clinchem.2015.250514

Cited by 22 publications

(10 citation statements)

References 20 publications

(15 reference statements)

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“…In contrast, changing CK-MB to a research-only test and creating a hard stop for FTP virtually eliminated orders. These findings corroborate previous studies that have shown significant test volume reduction with hard stop interventions45–47 and less impact with soft stops 43 46 48–50. This could be attributable to alert fatigue51 since the per cent reductions following soft stops tend to be similar regardless of test type which suggests an underlying systematic process.…”

Section: Discussionsupporting

confidence: 90%

Improving laboratory test utilisation at the multihospital Yale New Haven Health System

et al. 2019

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BackgroundWaste persists in healthcare and negatively impacts patients. Clinicians have direct control over test ordering and ongoing international efforts to improve test utilisation have identified multifaceted approaches as critical to the success of interventions. Prior to 2015, Yale New Haven Health lacked a coherent strategy for laboratory test utilisation management.MethodsIn 2015, a system-wide laboratory formulary committee was formed at Yale New Haven Health to manage multiple interventions designed to improve test utilisation. We report here on specific interventions conducted between 2015 and 2017 including reduction of (1) obsolete or misused testing, (2) duplicate orders, and (3) daily routine lab testing. These interventions were driven by a combination of modifications to computerised physician order entry, test utilisation dashboards and physician education. Measurements included test order volume, blood savings and cost savings.ResultsTesting for a number of obsolete/misused analytes was eliminated or significantly decreased depending on alert rule at order entry. Hard stops significantly decreased duplicate testing and educational sessions significantly decreased daily orders of routine labs and increased blood savings but the impact waned over time for select groups. In total, we realised approximately $100 000 of cost savings during the study period.ConclusionThrough a multifaceted approach to utilisation management, we show significant reductions in low-value clinical testing that have led to modest but significant savings in both costs and patients’ blood.

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Section: Discussionsupporting

confidence: 90%

Improving laboratory test utilisation at the multihospital Yale New Haven Health System

et al. 2019

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“…Dans notre étude, la diminution significative d'examens tels que les bilans lipidiques (-80 %), les mesure d'HbA1C (-93 %), les groupages sanguins (-62 %) et RAI (-18 %) reflète largement la redondance fréquente de ces examens dans la pratique quotidienne et le fait qu'elle semble pouvoir être évitée par des moyens simples (via le patient ou son laboratoire habituel). Des alertes informatiques peuvent également permettre d'identifier et limiter la multiplication d'examens non justifiées [11], mais la consultation des données antérieures n'est souvent applicable que pour un centre donné, à moins de mettre en réseau des résultats biologiques de plusieurs centres hospitaliers.…”

Section: Figure 3 : éVolution Des Volumes De Prescription Des Examensunclassified

Rationalisation des examens biologiques en cardiologie

Corré¹,

Douard²

2018

Santé Publique

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La reproduction ou représentation de cet article, notamment par photocopie, n'est autorisée que dans les limites des conditions générales d'utilisation du site ou, le cas échéant, des conditions générales de la licence souscrite par votre établissement. Toute autre reproduction ou représentation, en tout ou partie, sous quelque forme et de quelque manière que ce soit, est interdite sauf accord préalable et écrit de l'éditeur, en dehors des cas prévus par la législation en vigueur en France. Il est précisé que son stockage dans une base de données est également interdit.

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“…Prior studies have addressed the use of CDSS on laboratory ordering practices in the outpatient setting, but few have addressed the utility in the inpatient setting with only a recent emphasis on targeting redundant laboratory ordering . We conducted a prospective pilot study to evaluate the effect of nonintrusive CDSS on the inpatient utilization of serum and red blood cell (RBC) folate levels, hepatitis C virus (HCV) viral loads (VL) and genotypes, and type and screens (T&S) in a large academic centre.…”

Section: Introductionmentioning

confidence: 99%

Impact of nonintrusive clinical decision support systems on laboratory test utilization in a large academic centre

Eaton

Chida

Apfel

et al. 2018

Evaluation Clinical Practice

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Background: The near-universal prevalence of electronic health records (EHRs) has made the utilization of clinical decision support systems (CDSS) an integral strategy for improving the value of laboratory ordering. Few studies have examined the effectiveness of nonintrusive CDSS on inpatient laboratory utilization in large academic centres. Methods: Red blood cell folate, hepatitis C virus viral loads and genotypes, and type and screens were selected for study. We incorporated the appropriate indications for these labs into text that accompanied the laboratory orders in our hospital’s EHR. Providers could proceed with the order without additional clicks. An interrupted time-series analysis was performed, and the primary outcome was the rate of tests ordered on all inpatient medicine floors. Results: The rate of folate tests ordered per monthly admissions showed no significant level change at the time of the intervention with only a slight decrease in rate of 0.0109 (P = .07). There was a 43% decrease in the rate of hepatitis C virus tests per monthly admissions immediately after the intervention with a decrease of 0.0135 tests per monthly admissions (P = .02). The rate of type and screens orders per patient days each month had a significant downward trend by 0.114 before the intervention (P = .04) but no significant level change at the time of the intervention or significant change in rate after the intervention. Discussion: Our study suggests that nonintrusive CDSS should be evaluated for individual laboratory tests to ensure only effective alerts continue to be used so as to avoid increasing EHR fatigue.

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Implementation of Clinical Decision Support Rules to Reduce Repeat Measurement of Serum Ionized Calcium, Serum Magnesium, and N-Terminal Pro-B-Type Natriuretic Peptide in Intensive Care Unit Inpatients

Abstract: BACKGROUND:We assessed the impact of clinical decision support (CDS) rules within the electronic health record for ionized calcium (iCa), serum magnesium (Mg), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in intensive care unit (ICU) inpatients at a large academic center.

Cited by 22 publications

References 20 publications

Improving laboratory test utilisation at the multihospital Yale New Haven Health System

Improving laboratory test utilisation at the multihospital Yale New Haven Health System

Rationalisation des examens biologiques en cardiologie

Impact of nonintrusive clinical decision support systems on laboratory test utilization in a large academic centre

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