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Reducing duplicate testing: a comparison of two clinical decision support tools.

Gary W Procop1, Catherine Keating2, Paul Stagno2

  • 1From the Cleveland Clinic, Cleveland, OH. procopg@ccf.org.

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|April 16, 2015
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Implementing a "Hard Stop" alert system significantly reduces unnecessary duplicate laboratory testing compared to a "Smart Alert." This intervention saves costs and improves efficiency in healthcare settings.

Keywords:
Clinical decision supportMeaningful useTest utilization

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Area of Science:

  • Clinical Informatics
  • Health Services Research
  • Laboratory Medicine

Background:

  • Unnecessary duplicate laboratory testing presents a significant financial burden and operational challenge in healthcare.
  • Developing effective systems-based interventions is crucial to mitigate wasteful diagnostic practices.

Purpose of the Study:

  • To compare the efficacy and cost-effectiveness of two clinical decision support (CDS) tools designed to prevent duplicate laboratory orders.
  • To evaluate the impact of different alert functionalities on provider behavior and resource utilization.

Main Methods:

  • A comparative study was conducted using two CDS tools: a 'Hard Stop' alert requiring direct laboratory contact and justification, and a 'Smart Alert' allowing provider bypass.
  • Effectiveness was measured by the reduction in duplicate test orders, and cost savings were calculated per alert activation.

Main Results:

  • The 'Hard Stop' alert demonstrated significantly higher effectiveness in preventing duplicate testing (92.3%) compared to the 'Smart Alert' (42.6%; P < .0001).
  • Cost savings per alert activation were substantially greater for the 'Hard Stop' ($16.08) versus the 'Smart Alert' ($3.52).

Conclusions:

  • System-level process changes mandating laboratory contact and justification for duplicate tests are superior to passive alerts.
  • Interventions that create procedural barriers, such as requiring justification for overrides, are more effective in curbing unnecessary laboratory utilization.