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Reducing Unnecessary Complete Blood Count Ordering Through Education and Standardization: A Quality Improvement
Veena R Gujju1, Mahmood Khattab, Valerie Kastens
1Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City (Drs Gujju, Mahmood Khattab, Kastens, and Saeed); Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, College of Public Health, Oklahoma City (Dr Chen); and Department of Internal Medicine, Division of Cardiovascular Diseases, University of Oklahoma Health Sciences Center, Oklahoma City (Dr Mohamad Khattab).
Insights
Implementing an educational lecture and a simplified algorithm significantly reduced repetitive complete blood count (CBC) orders and saved costs without impacting patient readmissions.
Area of Science:
- Internal Medicine
- Healthcare Management
- Clinical Practice Improvement
Background:
- The Choosing Wisely campaign advises against unnecessary complete blood count (CBC) tests in stable patients.
- Repetitive CBC ordering contributes to healthcare costs and resource utilization.
Purpose of the Study:
- To evaluate the effectiveness of an educational intervention and a decision support algorithm in reducing daily CBC orders.
- To assess the impact of these interventions on healthcare costs and patient safety.
Main Methods:
- A prospective study involving consecutive patients admitted to a teaching team.
- Interventions included an educational lecture on CBC costs/indications and a simplified daily CBC ordering algorithm.
- Primary outcome was CBCs ordered per patient per day; secondary outcome was net cost savings. Balancing measure was 7-day ED visits/readmissions.
Main Results:
- A significant reduction in CBC ordering was observed after implementing both interventions (P = .000317).
- Total net cost savings amounted to $43,482.
- There was no significant difference in 7-day emergency department visits or readmissions between groups (P = .1403).
Conclusions:
- Educational interventions and a simplified algorithm effectively improved CBC ordering patterns and reduced costs.
- The interventions were safe, showing no increase in adverse patient outcomes like readmissions.
- This approach offers a sustainable method for optimizing laboratory test utilization in hospital settings.
Background And Objectives:
The American Board of Internal Medicine's Choosing Wisely campaign recommends against ordering repetitive complete blood counts (CBC) in the face of clinical and laboratory stability.
Methods:
Consecutive patients admitted to a teaching team were included. Intervention 1 was an educational lecture outlining costs of and indications for CBC ordering. Intervention 2 added a simplified algorithm to help providers determine the need for a daily CBC. The primary outcome measure was the number of CBCs ordered per number of patients per day. The secondary outcome measure was net cost saved. The process measures were lecture/poster and algorithm utilization rates. The balancing measure was emergency department visits/readmissions within 7 days of discharge. A statistical process control chart was generated to assess special cause variation. Using R software version 3.5.2, a 2-sample t test and Fisher exact test differences between groups in the outcome and balancing measures.
Results:
One hundred ten patients were included over a 62-day period. The difference between the pre-intervention group and both interventions combined was significant ( P = .000317). Special cause variation was observed after institution of both interventions in conjunction. Net costs saved totaled $43 482. Emergency department visits/readmissions within 7 days were similar between the groups ( P = .1403).
Conclusions:
Complete blood count ordering patterns and costs were improved through education and providing a decision support tool in the form of a simplified algorithm, without increasing 7-day emergency department visits/readmissions. The algorithm, far less detailed than that previously published, still resulted in significant improvement without unintended consequences, making for a safe and potentially sustainable intervention.
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