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Sustainable Laboratory-Driven Method to Decrease Repeat, Same-Day WBC Differentials at a Tertiary Care Center
Ann Tran1, Monika Hudoba1,2, Todd Markin2
1Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada.
Insights
Implementing a laboratory middleware algorithm effectively canceled repeat, same-day White Blood Cell (WBC) differentials, significantly improving laboratory resource allocation and reducing costs.
Area of Science:
- Clinical Laboratory Science
- Health Informatics
- Healthcare Management
Background:
- Complete Blood Count (CBC) with White Blood Cell (WBC) differential testing is frequently ordered when a CBC alone suffices.
- Unnecessary WBC differentials contribute to increased laboratory costs and inefficient resource allocation.
Purpose of the Study:
- To implement a laboratory middleware algorithm to automatically cancel repeat, same-day WBC differentials.
- To achieve sustainable improvements in laboratory resource utilization and cost savings.
Main Methods:
- A middleware algorithm was developed to identify and cancel redundant, same-day WBC differentials.
- The algorithm was initially trialed in intensive care units before hospital-wide implementation.
- Retrospective review of CBC with differential orders pre- and post-implementation was conducted.
Main Results:
- The algorithm achieved a monthly cancellation rate of 5.40% for WBC differentials, totaling 10,195 cancellations.
- An estimated $0.99 CAD in savings per canceled differential and 1,060 minutes of technologist time were realized.
- Over 99.9% of canceled differentials remained canceled, with minimal patient impact.
Conclusions:
- A middleware algorithm offers a simple and sustainable solution for optimizing laboratory utilization.
- Automated cancellation of repeat WBC differentials leads to significant cost savings and improved efficiency.
- This approach demonstrates lasting improvements in laboratory resource management.
Objectives:
A CBC with WBC differential is often ordered when a CBC alone would be sufficient for patient care. Performing unnecessary WBC differentials adds to costs in the laboratory. Our objective was to implement a laboratory middleware algorithm to cancel repeat, same-day WBC differentials to achieve lasting improvements in laboratory resource allocation.
Methods:
Repeat same-day WBC differentials were first canceled only on intensive care unit samples; after a successful trial period, the algorithm was applied hospital-wide. We retrospectively reviewed CBC with differential orders from pre- and postimplementation periods to estimate the reduction in WBC differentials and potential cost savings.
Results:
The algorithm led to a monthly WBC differential cancellation rate of 5.40% for a total of 10,195 canceled WBC differentials during the cumulative postimplementation period (September 25, 2019, to December 31, 2020). Nearly all (99.94%) differentials remained canceled. Most patients only had one WBC differential canceled (range, 1-38). Savings estimates showed savings of $0.99 CAD per canceled differential and 1,060 minutes (17.7 hours) of technologist time.
Conclusions:
A middleware algorithm to cancel repeat, same-day WBC differentials is a simple and sustainable way to achieve lasting improvements in laboratory utilization.
