Reduction of laboratory utilization in the intensive care unit

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.