Impact of Interventions to Change CBC and Differential Ordering Patterns in the Emergency Department

Area of Science:

• Clinical Pathology
• Health Services Research
• Emergency Medicine

Background:

• Complete blood count with leukocyte differential (CBC-DIFF) is a common emergency department (ED) test.
• The differential component of CBC-DIFF often lacks clinical utility in the ED setting.
• Overutilization of laboratory tests contributes to healthcare costs and potential patient harm.

Purpose of the Study:

• To evaluate the effectiveness of a performance improvement project on complete blood count (CBC) ordering in the ED.
• To assess the impact of an educational intervention and electronic medical record (EMR) order reprioritization on CBC-DIFF utilization.

Main Methods:

• A retrospective analysis of ED CBC-DIFF orders was conducted using laboratory information system data.
• Two interventions were implemented: an educational initiative and a change in EMR order prioritization for CBC-DIFF and CBC.
• Statistical analysis, including Pearson chi-squared tests, was used to compare ordering proportions before and after interventions.

Main Results:

• The educational intervention showed no significant change in the proportion of CBC tests performed.
• Reprioritization of EMR orders led to a significant increase in CBC sample orders (9.1%), contrary to the intended reduction.
• The study highlights unexpected outcomes from EMR intervention on ordering patterns.

Conclusions:

• The study's findings suggest that simply reprioritizing EMR orders may not effectively reduce overutilization of CBC-DIFF.
• Further investigation is needed to understand the complex factors influencing laboratory test ordering in the ED.
• Optimizing diagnostic test utilization requires multifaceted strategies beyond simple EMR modifications.