Clinical decision support to improve CBC and differential ordering

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.