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Removing Cerebrospinal Fluid Antibody Orders from the Test Menu Results in a Dramatic Decrease in Order Volume.

Stacy G Beal1, Elizabeth Tremblay2, Neil Harris1

  • 1Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, FL.

The Journal of Applied Laboratory Medicine
|February 27, 2021
PubMed
Summary
This summary is machine-generated.

Removing rarely useful cerebrospinal fluid (CSF) antibody tests for Lyme disease, toxoplasmosis, and cytomegalovirus from computerized physician order entry systems significantly reduced test orders. This intervention led to substantial cost savings and freed up CSF for more critical diagnostic applications.

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Area of Science:

  • Clinical diagnostics
  • Laboratory medicine
  • Infectious disease testing

Background:

  • Antibody testing for Borrelia burgdorferi, Toxoplasma gondii, and cytomegalovirus in cerebrospinal fluid (CSF) has limited clinical utility.
  • Computerized physician order entry (CPOE) systems can facilitate the overutilization of such tests due to convenience.

Purpose of the Study:

  • To evaluate the impact of removing specific CSF antibody tests from a CPOE system on test order volume and associated costs.
  • To determine if removing these tests leads to increased utilization of alternative diagnostic methods.

Main Methods:

  • Specific CSF antibody tests (cytomegalovirus, Borrelia burgdorferi, Toxoplasma gondii) were removed from the CPOE test menu.
  • Monthly test order volumes were collected and compared before and after the removal.
  • Order volumes for related PCR tests were monitored for compensatory increases.

Main Results:

  • Orders for CSF antibody tests for Borrelia burgdorferi, Toxoplasma gondii, and cytomegalovirus decreased by 91%, 93%, and 98%, respectively.
  • The intervention resulted in annual cost savings of $50,053.44.
  • No significant increase in CMV or T. gondii PCR orders was observed post-intervention.

Conclusions:

  • Removing infrequently useful diagnostic tests from CPOE systems can drastically reduce test ordering.
  • This strategy leads to significant cost savings and improves the availability of CSF for more appropriate diagnostic tests.
  • Providers did not substitute removed tests with alternative related tests, suggesting a successful reduction in unnecessary testing.