"Lipase Only, Please": Reducing Unnecessary Amylase Testing

Area of Science:

• Quality Improvement
• Healthcare Management
• Clinical Practice Optimization

Background:

• Serum amylase testing is frequently ordered for acute pancreatitis, despite not being recommended.
• Unnecessary diagnostic testing contributes to healthcare costs and resource utilization.

Purpose of the Study:

• To evaluate the effectiveness of a quality improvement initiative in reducing unnecessary serum amylase orders.
• To assess the impact of education and electronic medical record (EMR) interventions on laboratory test ordering.

Main Methods:

• A pre-post study design was implemented across two urban hospitals (academic and community).
• Interventions included an educational campaign, decoupling amylase from order sets, and EMR advisory statements.
• Serum amylase orders were tracked for emergency department visits and hospital admissions from January 2016 to May 2018.

Main Results:

• Significant and sustained reductions in monthly amylase orders were observed at both hospitals.
• The academic hospital saw a decrease from 3,214 to 2,348 orders/month (p=0.011).
• The community hospital saw a decrease from 100 to 23 orders/month (p=0.001).
• EMR advisory statements were independently associated with reduced ordering.
• An estimated net annual cost reduction of $44,999 was achieved.

Conclusions:

• A student-led initiative effectively reduced unnecessary serum amylase ordering through a multi-faceted approach.
• Education, publicity, and EMR changes were key components of the successful intervention.
• This initiative demonstrates a practical strategy for optimizing diagnostic test utilization in acute care settings.