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Rational Clinical Pathology Assessment in the Intensive Care Unit.

K S Rachakonda1, M Parr2, A Aneman3

  • 1Senior Staff Specialist, Intensive Care, Liverpool Hospital, Conjoint Senior Lecturer, University of New South Wales, Sydney, New South Wales.

Anaesthesia and Intensive Care
|July 5, 2017
PubMed
Summary
This summary is machine-generated.

Implementing specialist authorization for routine blood tests in intensive care units (ICUs) significantly reduced laboratory costs by 12.3%. This change in practice demonstrated cost savings without adverse patient outcomes.

Keywords:
blood gas analysis, coagulation testsintensive care units, tertiary, guidelines, senior medical staff, clinical pathology, costing, blood cell count, electrolytes

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Area of Science:

  • Critical Care Medicine
  • Clinical Pathology
  • Health Economics

Background:

  • Routine blood testing is a daily practice in intensive care units (ICUs).
  • Current guidelines for ICU laboratory testing requirements are not widely established.
  • Unrestricted ordering of tests contributes to significant healthcare expenditure.

Purpose of the Study:

  • To evaluate the impact of a multi-strategy practice change on ICU laboratory test costs.
  • To assess the effect of intensive care unit (ICU) specialist authorization of high-volume routine tests on laboratory expenditures.
  • To determine if changes in testing protocols affect patient safety.

Main Methods:

  • A single-center, prospective, interventional study with historical controls was conducted.
  • During a six-month intervention, ICU specialists authorized all routine blood tests.
  • Nursing and junior medical staff previously had direct ordering privileges.
  • Adverse events related to test omission were systematically recorded.

Main Results:

  • Overall ICU laboratory test costs decreased by 12.3% (P=0.0022) compared to historical controls.
  • Costs for high-volume tests, including blood gas analyses, chemistry panels, coagulation, and complete blood counts, decreased by 20%.
  • Mean compliance with the test authorization protocol was 51%.
  • Two minor, protocol-related adverse events occurred, both resolved without negative patient outcomes.

Conclusions:

  • Intensive care unit (ICU) specialist authorization of routine blood tests is associated with significant cost savings.
  • This practice change can reduce laboratory expenditures without compromising patient safety.
  • Implementing controlled testing protocols is a viable strategy for cost containment in ICUs.