An electronic health record-based solution to reduce the volume of CBC differentials performed on inpatients

We sought to investigate the use of same-day, repeat complete blood cell count (CBC) with differential orders in a large pediatric institution and design an intervention to limit CBC with differential testing and, thereby, manual differential performance to once per calendar day, without placing a burden on ordering clinicians.

We created a seamless electronic health record (EHR)-based back-end workflow that reaccessions CBC with differential orders to a CBC without differential if a CBC with differential has been resulted within that calendar day. Clinicians have an opportunity to override at the time of test order entry in the EHR.

Repeat CBC with differential orders originated predominantly in intensive care units (ICUs) and oncology inpatient units and accounted for 18% of all CBC with differential orders. Implementation of our EHR workflow led to an average annual reduction of 9% in CBC with differential tests and a 16% reduction in manual differentials performed. This change amounts to a combined annual cost savings (direct cost of testing plus laboratory technologist time) of approximately $45 000 and improved CBC with differential test turnaround times.

Our EHR-based solution resulted in a substantial and sustained decrease in CBC with differential tests and manual differential slide reviews performed in a critically ill pediatric population. This approach is a potential alternative to traditional educational and other clinician-dependent stewardship interventions that aim to improve test utilization.