Improving the appropriateness of serum magnesium testing in an intensive care unit

Lo, An-Ya; Zhao, Tongtiegang; Rajapakse, Sanjeeva; Leung, Arnold; Chow, J.C.H.; Wong, Rebecca; Norena, Monica; Dodek, Peter

doi:10.1007/s12630-020-01654-z

Cited by 1 publication

(3 citation statements)

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“…); Gatekeeping (withdrawal of routine panel testing and routine admission panel testing); A&F (number of tests during intervention); Pre-I: 12 mo Post-I: 12 mo Reduction of routine admission tests from 47.0 to 24.9 (−47%) per ICU admission (= ~ 50,000 in absolute number of tests /y.) AUD 794000 /y No increase in mortality nor LOS; reduction of transfusions and MV needed Lo et al [ 77 ] 2020 Prospective BAA (L.Ed.) 15-bed MG Education (monthly sessions); CPOE (prompts); Guidance (indications for testing) Pre-I: 1 y Post-I: 11 mo Overall reduction from 0.71 to 0.57 (−20%) TPD with reduction from 0.57 to 0.41 (−39%) for routine tests and stable non-routine tests CAD 4500 /y No difference in mortality or LOS Maguet et al [ 58 ] 2015 Prospective BAA (L.Ed.)…”

Section: Interventions To Improve Laboratory Testing Appropriateness ...mentioning

confidence: 99%

“…Post-intervention, the guideline was changed for admission and daily testing, so that only diagnostic tests deemed clinically indicated and explicitly suggested by the treating ICU team were requested.” Lo et al (L.Ed.) [ 77 ] 2020 MG Guidance locally established 1° Suspected hypomagnesemia with plans to replete in the setting of renal failure; 2° Optional in suspected hypermagnesemia Martinez-B. et al [ 88 ] 2017 ABG Guidance locally established 1° Should an ABG be drawn ?…”

Section: Interventions To Improve Laboratory Testing Appropriateness ...mentioning

confidence: 99%

“…Lo et al . [ 76 , 77 ] assessed serum magnesium testing with educational, guidance and CPOE-based interventions. They educated rotating medical and nursing staff in conjunction with a CPOE prompt displaying indications for testing.…”

Section: Interventions To Improve Laboratory Testing Appropriateness ...mentioning

confidence: 99%

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Interventions to improve appropriateness of laboratory testing in the intensive care unit: a narrative review

Devis,

Catry,

Honore

et al. 2024

Ann. Intensive Care

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Healthcare expenses are increasing, as is the utilization of laboratory resources. Despite this, between 20% and 40% of requested tests are deemed inappropriate. Improper use of laboratory resources leads to unwanted consequences such as hospital-acquired anemia, infections, increased costs, staff workload and patient stress and discomfort. The most unfavorable consequences result from unnecessary follow-up tests and treatments (overuse) and missed or delayed diagnoses (underuse). In this context, several interventions have been carried out to improve the appropriateness of laboratory testing. To date, there have been few published assessments of interventions specific to the intensive care unit. We reviewed the literature for interventions implemented in the ICU to improve the appropriateness of laboratory testing. We searched literature from 2008 to 2023 in PubMed, Embase, Scopus, and Google Scholar databases between April and June 2023. Five intervention categories were identified: education and guidance (E&G), audit and feedback, gatekeeping, computerized physician order entry (including reshaping of ordering panels), and multifaceted interventions (MFI). We included a sixth category exploring the potential role of artificial intelligence and machine learning (AI/ML)-based assisting tools in such interventions. E&G-based interventions and MFI are the most frequently used approaches. MFI is the most effective type of intervention, and shows the strongest persistence of effect over time. AI/ML-based tools may offer valuable assistance to the improvement of appropriate laboratory testing in the near future. Patient safety outcomes are not impaired by interventions to reduce inappropriate testing. The literature focuses mainly on reducing overuse of laboratory tests, with only one intervention mentioning underuse. We highlight an overall poor quality of methodological design and reporting and argue for standardization of intervention methods. Collaboration between clinicians and laboratory staff is key to improve appropriate laboratory utilization. This article offers practical guidance for optimizing the effectiveness of an intervention protocol designed to limit inappropriate use of laboratory resources.

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Section: Interventions To Improve Laboratory Testing Appropriateness ...mentioning

confidence: 99%

Section: Interventions To Improve Laboratory Testing Appropriateness ...mentioning

confidence: 99%

See 1 more Smart Citation

Interventions to improve appropriateness of laboratory testing in the intensive care unit: a narrative review

Devis,

Catry,

Honore

et al. 2024

Ann. Intensive Care

View full text Add to dashboard Cite

show abstract

Improving the appropriateness of serum magnesium testing in an intensive care unit

Cited by 1 publication

References 4 publications

Interventions to improve appropriateness of laboratory testing in the intensive care unit: a narrative review

Interventions to improve appropriateness of laboratory testing in the intensive care unit: a narrative review

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