Reduction of laboratory utilization in the intensive care unit

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dc.contributor.author Diab, Khalil
dc.contributor.author Eliott, Rachel
dc.contributor.author Raad, Samih
dc.contributor.author Dickerson, Evan
dc.date.accessioned 2019-02-13T10:07:07Z
dc.date.available 2019-02-13T10:07:07Z
dc.date.copyright 2016 en_US
dc.date.issued 2019-02-13
dc.identifier.issn 1525-1489 en_US
dc.identifier.uri http://hdl.handle.net/10725/10030
dc.description.abstract Objective: In our academic intensive care unit (ICU), there is excess ordering of routine laboratory tests. This is partially due to a lack of transparency of laboratory-processing costs and to the admission order plans that favor daily laboratory test orders. We hypothesized that a program that involves physician and staff education and alters the current ICU order sets will lead to a sustained decrease in routine laboratory test ordering. Design: Prospective cohort study. Setting: Academic closed medical ICU (MICU). Patients: All patients admitted to the MICU. Methods: We consistently educated residents, faculty, and staff about laboratory test costs. We removed the daily laboratory test option from the admission order sets and asked residents to order needed laboratory test results every day. We only allowed the G3+I-STAT (arterial blood gas only) cartridges in the MICU in hopes of decreasing duplicative laboratory test results. We added laboratory review to the daily rounding checklist. Measurement and Main Results: Total number of laboratory tests per patient-day decreased from 39.43 to an average of 26.74 (P <.001) over a 9-month period. The number of iSTAT laboratory tests per patient-day decreased from 7.37 to an average of 1.16 (P < .001) over the same time period. The number of iSTAT/central laboratory processing duplicative laboratory tests per patient-day decreased from 0.17 to an average of 0.01 (P < .001). The percentage of patients who have daily laboratory test orders decreased from 100% to an average of 11.94% (P <. 001). US$123 436 in direct savings and US$258 035 dollars in indirect savings could be achieved with these trends. Intensive care unit morbidity and mortality were not impacted. Conclusion: A simple technique of resident, nursing, and ancillary staff education, combined with alterations in order sets using electronic medical records, can lead to a sustained reduction in laboratory test utilization over time and to significant cost savings without affecting patient safety. en_US
dc.language.iso en en_US
dc.title Reduction of laboratory utilization in the intensive care unit en_US
dc.type Article en_US
dc.description.version Published en_US
dc.author.school SOM en_US
dc.author.idnumber 201900605 en_US
dc.author.department N/A en_US
dc.description.embargo N/A en_US
dc.relation.journal Journal of Intensive Care Medicine en_US
dc.journal.volume 32 en_US
dc.journal.issue 8 en_US
dc.article.pages 500-507 en_US
dc.keywords Intensice care en_US
dc.keywords Medical care cost en_US
dc.keywords Clinical laboratory services en_US
dc.keywords Radiography en_US
dc.keywords Thoracic en_US
dc.keywords Cost savings en_US
dc.keywords Patient satisfaction en_US
dc.identifier.doi https://doi.org/10.1177/0885066616651806 en_US
dc.identifier.ctation Raad, S., Elliott, R., Dickerson, E., Khan, B., & Diab, K. (2017). Reduction of laboratory utilization in the intensive care unit. Journal of intensive care medicine, 32(8), 500-507. en_US
dc.author.email khalil.diab@lau.edu.lb en_US
dc.identifier.tou http://libraries.lau.edu.lb/research/laur/terms-of-use/articles.php en_US
dc.identifier.url https://journals.sagepub.com/doi/full/10.1177/0885066616651806 en_US
dc.orcid.id https://orcid.org/0000-0001-9255-7575 en_US
dc.author.affiliation Lebanese American University en_US

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