Stewardship of Inpatient A1c Testing: An Electronic Nudge to Limit Testing after Red Cell Transfusion.

Area of Science:

• Clinical Informatics
• Endocrinology
• Laboratory Medicine

Background:

• Guidelines recommend glycated hemoglobin (HgbA1C) testing for inpatients with diabetes mellitus.
• Electronic health systems often default HgbA1C orders, leading to potential errors.
• Recent red blood cell transfusions can falsely lower HgbA1C values, impacting patient management.

Purpose of the Study:

• To evaluate a non-interruptive clinical decision support (CDS) intervention.
• To reduce automatic HgbA1C testing in patients with recent red blood cell transfusions.
• To minimize erroneous HgbA1C results and associated healthcare waste.

Main Methods:

• Retrospective observational analysis over 40 months.
• Assessed HgbA1C test orders within 7 days of red blood cell transfusion.
• Compared pre-intervention and post-intervention testing rates.

Main Results:

• Pre-intervention: 11.7% (97/month) of HgbA1C tests were on patients with recent transfusions.
• Post-intervention: Testing decreased to 5.8% (48/month).
• Total monthly HgbA1C tests remained stable (827 vs. 832).

Conclusions:

• A non-interruptive CDS intervention significantly reduced HgbA1C tests in transfused patients.
• The intervention minimized erroneous HgbA1C values and healthcare waste.
• This approach improved testing accuracy without clinician alert fatigue.