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Utilization of LDH isoenzymes in the diagnosis of myocardial infarction
J R Petersen1, E Smith, A O Okorodudu
1Department of Laboratory Medicine/Pathology, University of Texas Medical Branch, Galveston, USA.
Insights
Healthcare systems face pressure to reduce laboratory test costs. This study reduced the routine use of lactate dehydrogenase (LDH) isoenzymes in suspected myocardial infarction (MI) patients, saving costs and technician time.
Area of Science:
- Clinical Chemistry
- Healthcare Management
- Cardiology
Background:
- Managed care necessitates cost reduction in healthcare services.
- Laboratory testing, including creatine kinase-MB (CK-MB) and lactate dehydrogenase (LDH) isoenzymes, is a target for cost-saving measures.
- Routine ordering of LDH isoenzymes for patients with suspected myocardial infarction (MI) contributes to unnecessary expenses.
Purpose of the Study:
- To evaluate strategies for reducing the utilization of LDH isoenzymes in patients with suspected MI.
- To decrease laboratory costs associated with diagnostic testing for MI.
- To optimize laboratory test ordering patterns in response to managed care pressures.
Main Methods:
- Collaborated with the Division of Cardiology to revise patient triage protocols for suspected MI.
- Implemented a policy requiring director approval before reporting LDH isoenzyme test results.
- Analyzed ordering patterns of LDH isoenzymes before and after intervention.
Main Results:
- LDH isoenzymes were routinely ordered in at least 14% of cases involving suspected MI.
- The implemented strategies significantly reduced the unnecessary use of LDH isoenzymes.
- Cost savings were achieved through decreased reagent use and technician time.
Conclusions:
- Protocol changes and approval requirements are effective in reducing the routine use of expensive laboratory tests like LDH isoenzymes.
- Optimizing laboratory test utilization is crucial for cost containment in healthcare.
- Interdisciplinary collaboration can lead to successful implementation of cost-saving measures in diagnostic testing.
Abstract:
With the arrival of managed care, increased pressure is being placed on the health-care system to reduce the use of laboratory services. When evaluating less expensive methods to measure CK-MB to help reduce costs of triaging patients suspected of having myocardial infarction (MI), we also had an opportunity to evaluate the ordering pattern of LDH isoenzymes for these same patients. We found that LDH isoenzymes were continuously ordered as a routine test at least 14% of the time. We worked with the Division of Cardiology to reduce the use of LDH isoenzymes in two ways: 1) by changing the protocol of triaging suspected MI patients and 2) by reporting the test result only after director approval. This article summarizes our approach to reducing the use of LDH isoenzymes, an expensive test in terms of reagent cost and technician time.
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