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Reducing laboratory costs through rational testing in suspected pre-eclampsia.

Adam Daniel Jakes¹, Marsha Cox², Simon Drane²

¹Maternity services, Epsom and St Helier University Hospitals NHS Trust, Carshalton, UK a.jakes@nhs.net.

BMJ Open Quality

|March 11, 2022

Summary

Removing non-recommended tests like gamma-glutamyltransferase and uric acid from pre-eclampsia order sets significantly reduced lab requests and calls. This improved efficiency and saved resources without impacting patient care.

Keywords:

cost-effectiveness electronic health records healthcare quality improvement information technology obstetrics and gynaecology

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Area of Science:

Clinical Chemistry
Obstetrics and Gynecology
Healthcare Management

Background:

Current pre-eclampsia electronic order sets include gamma-glutamyltransferase (GGT) and uric acid, despite guidelines not recommending them.
These markers are poor predictors of maternal and neonatal outcomes in pre-eclampsia management.
Clinical staff confirmed non-use of these markers in patient assessment.

Purpose of the Study:

To evaluate the impact of removing GGT and uric acid from electronic laboratory order sets for suspected pre-eclampsia.
To assess the effect on laboratory request numbers and clinical workflow efficiency.

Main Methods:

Stakeholder engagement to confirm non-use of GGT and uric acid in clinical practice.
Quantified baseline GGT and uric acid requests over two months.
Removed GGT and uric acid from the electronic order set.
Quantified post-intervention requests over two months and assessed sustainability at eight months.

Main Results:

Significant reduction in GGT and uric acid laboratory requests from the maternity department.
Substantial decrease in laboratory phone calls escalating abnormal results.
Project demonstrated sustainability eight months post-intervention.

Conclusions:

Removing non-recommended tests from electronic order sets is effective in reducing unnecessary laboratory utilization.
This intervention streamlines clinical workflow, saves resources, and reduces staff time.
Optimizing laboratory order sets aligns with evidence-based practice and improves healthcare efficiency.