Quality assurance in the intensive care unit--monitoring hematocrit orders

To provide a quality assurance (QA) study in the intensive care unit (ICU), hematocrit orders were monitored for five months (September 1989-January 1990) in an attempt to determine appropriate practice. Computer prints of all hematocrits (hct) ordered in the ICU were reviewed. Of all patients admitted to the unit in this time (528), 61 percent (319) had hematocrits ordered. The maximum number ordered per day varied from one to six with a mean of 1.4. All patients having three or more hcts per day (46) were reviewed by one or more of the authors to determine the circumstances. The patients consisted of 27 men and 19 women between the ages of 16 to 92 years with a median of 70 years. Thirty-three (72 percent) were 60 years of age or older. Twenty-seven were patients with active bleeding. Most had need for hct clearly delineated. In 11 others, justification was not clearly delineated, but resulted from blanket orders when vital signs were stable. In eight patients, multiple hcts were not necessary, but were obtained because of confusing orders or clerical error. These observations suggest that QA review of laboratory orders from the ICU will detect a few abuses and will find some patients whose laboratory tests could be optimized in an educational setting.