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Clinical decision support to improve CBC and differential ordering
Grace K Mahowald1, Kent B Lewandrowski1, Anand S Dighe1
1Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, US.
Insights
Clinical decision support (CDS) alerts significantly reduced unnecessary complete blood count with differential (CBC diff) orders in hospitals. This led to fewer manual differentials and faster turnaround times, improving patient care quality.
Area of Science:
- Clinical Pathology
- Health Informatics
- Laboratory Medicine
Background:
- Complete blood count with differential (CBC diff) is frequently ordered in inpatient settings.
- Overutilization and misordering of CBC diff can lead to unnecessary laboratory workload and costs.
- Clinical decision support (CDS) systems offer a potential solution to optimize test ordering.
Purpose of the Study:
- To evaluate the effectiveness of CDS alerts in reducing inappropriate CBC diff orders among inpatients.
- To assess the impact of CDS alerts on laboratory workflow and turnaround times for manual differentials.
Main Methods:
- Three distinct CDS alerts were developed to target specific ordering frequencies: daily, more than daily, and as needed.
- These alerts provided guidance to healthcare providers ordering CBC diff for inpatients.
- The study analyzed changes in CBC diff order volume and manual differential performance post-implementation.
Main Results:
- Implementation of the CDS alerts resulted in a 32% overall decrease in CBC diff test volume.
- Manual differentials performed decreased by 22% following alert implementation.
- Turnaround time for manual differentials improved, with a mean reduction of 41.5 minutes, and up to 90 minutes during peak hours.
Conclusions:
- CDS alerts are effective in reducing inpatient CBC diff orders.
- The alerts successfully decreased the frequency of unnecessary laboratory testing.
- Improved turnaround times for manual differentials indicate enhanced quality of patient care.
Objectives:
Complete blood count and differential (CBC diff) is a common laboratory test that may be overused or misordered, particularly in an inpatient setting. We assessed the ability of a clinical decision support (CDS) alert to decrease unnecessary orders for CBC diff and analyzed its impact in the laboratory.
Methods:
We designed 3 CDS alerts to provide guidance to providers ordering CBC diff on inpatients at frequencies of daily, greater than once daily, or as needed.
Results:
The 3 alerts were highly effective in reducing orders for CBC diff at the frequencies targeted by the alert. Overall, test volume for CBC diff decreased by 32% (mean of 5257 tests per month) after implementation of the alerts, with a corresponding decrease of 22% in manual differentials performed (mean of 898 per month). Turnaround time for manual differentials decreased by a mean of 41.5 minutes, with a mean decrease of up to 90 minutes during peak morning hours.
Conclusions:
The 3 CDS alerts successfully decreased inpatient orders for CBC diff and improved the quality of patient care by decreasing turnaround time for manual differentials.
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