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Related Concept Videos

Methods of Documentation V: CBE01:23

Methods of Documentation V: CBE

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Charting by Exception, or CBE, is a method of documentation used in healthcare, particularly in nursing, that focuses on documenting only significant or abnormal findings rather than recording every detail. This approach aims to streamline the documentation process, improve efficiency, and ensure that healthcare providers can quickly identify deviations from normalcy in patient assessments.
In CBE, healthcare professionals establish predefined standards of practice that define what constitutes...
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The case management model is a multidisciplinary approach that involves healthcare professionals from diverse disciplines, such as physicians, nurses, therapists, social workers, and pharmacists, working collaboratively to address the various needs of patients. Each healthcare professional brings unique expertise and perspectives, contributing to a more comprehensive understanding of the patient's condition and tailoring treatment plans accordingly.
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Database-guided Flow-cytometry for Evaluation of Bone Marrow Myeloid Cell Maturation
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Clinical decision support to improve CBC and differential ordering.

Grace K Mahowald1, Kent B Lewandrowski1, Anand S Dighe1

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American Journal of Clinical Pathology
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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.

Keywords:
CBC and differentialclinical decision supportinterruptive alertlaboratory managementlaboratory utilizationmanual differential

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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.