Improving serum calcium test ordering according to a decision algorithm

Abstract

<jats:sec><jats:title>Aim</jats:title><jats:p>To detect differences in the pattern of serum calcium tests ordering before and after the implementation of a decision algorithm.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We studied patients admitted to an internal medicine ward of a university hospital on April 2013 and April 2016. Patients were classified as critical or non-critical on the day when each test was performed. Adequacy of ordering was defined according to adherence to a decision algorithm implemented in 2014.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Total and ionised calcium tests per patient-day of hospitalisation significantly decreased after the algorithm implementation; and duplication of tests (total and ionised calcium measured in the same blood sample) was reduced by 49%. Overall adequacy of ionised calcium determinations increased by 23% (P=0.0001) due to the increase in the adequacy of ionised calcium ordering in non-critical conditions.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>A decision algorithm can be a useful educational tool to improve adequacy of the process of ordering serum calcium tests.</jats:p></jats:sec>

Successful demand management in diagnostic immunology testing

“…A review of ordering for in-hospital patients, published in 2017, found that: education had some impact on test ordering, but this was not sustained; feedback on comparative ordering practices among clinicians reduced frequent tests by around 11%, with another (small) study achieving 66% reduction in ionised calcium (but without much data on sustainability); and restriction on ordering within electronic systems reduced a set of common tests by 21% 29. More recently, a decision-recommendation algorithm for calcium testing for inpatients in a hospital Brazil decreased ordering by 23% 30…”