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Improved utilization of operating room acid-fast bacilli and fungal culture ordering through "quick button"
Shivani Satia1, Jennifer Pfeiffer1, Yingzhe Kuang2
1Department Pathology & Cell Biology, Columbia University Irving Medical Center, New York, NY, 10032, United States.
Objective:
Default settings in electronic medical records (EMRs) can drive overordering of diagnostic tests. After transitioning to Epic, our hospital network noted a sharp rise in acid-fast bacilli (AFB) and fungal culture orders from operating rooms (ORs), likely due to 1-click ordering tools ("quick buttons") in the Epic OpTime module. We assessed the impact of removing these buttons on test utilization.
Methods:
This multicenter study included 8 medical centers and compared two 9-month periods: preintervention (January to September 2023) and postintervention (December 2023 to August 2024). The AFB and fungal cultures remained orderable via manual entry. Order volumes, positivity rates, and turnaround times (TATs) were extracted from the Laboratory Information System.
Results:
Postintervention, AFB orders decreased by nearly 50% (P < .001) while positivity doubled (1.74% to 3.64%, P < .001). Median AFB TAT improved by more than 2 hours (P < .001). Fungal culture orders declined 35% (P < .001), with no significant change in positivity (6.37% vs 6.25%, P = .83). Median fungal TAT improved by more than 1 hour (P < .001).
Conclusions:
Removing OR quick buttons significantly reduced unnecessary AFB and fungal culture orders and improved TAT without reducing detection of clinically important infections. This is the first study to evaluate the impact of EMR quick buttons on -microbiology utilization.
