Management of procalcitonin test overuse in an emergency department through a computer algorithm

Area of Science:

• Clinical Chemistry
• Health Economics
• Diagnostic Test Optimization

Background:

• Procalcitonin (PCT) testing is frequently used in emergency departments (EDs) for diagnosing bacterial infections.
• Overutilization of PCT tests can lead to increased healthcare costs without significant clinical benefit in all cases.
• Developing strategies to judiciously decrease PCT measurement is crucial for resource optimization.

Purpose of the Study:

• To assess the demand for procalcitonin (PCT) tests in an emergency department (ED) over several years.
• To implement a computerized algorithm utilizing C-reactive protein (CRP) values to reduce unnecessary PCT measurements.
• To evaluate the economic savings resulting from decreased PCT testing.

Main Methods:

• A cross-sectional study was conducted to evaluate an intervention aimed at reducing PCT measurement in the ED based on low CRP values.
• Diagnostic indicators for PCT were calculated at various CRP cutoffs, using PCT quantification as the gold standard.
• A strategy was implemented where PCT was not measured if CRP values were below a defined threshold (0.8 mg/dL).

Main Results:

• A CRP cutoff of 0.8 mg/dL was established, yielding a 1% false-negative rate for PCT and a 99th percentile PCT of 1.5 ng/mL.
• During the post-intervention period, 1091 PCT tests were avoided.
• The intervention resulted in estimated cost savings of $11,553.69.

Conclusions:

• An intervention, developed by clinical laboratory staff in collaboration with clinicians, effectively decreased PCT testing in the ED.
• The algorithm, based on C-reactive protein (CRP) values, successfully reduced procalcitonin (PCT) measurements.
• This strategy generated substantial economic savings, demonstrating the value of evidence-based test utilization.