Eliminating needless testing in intensive care--an information-based team management approach

Area of Science:

• Critical Care Medicine
• Health Informatics
• Healthcare Management

Background:

• Intensive care units (ICUs) utilize extensive laboratory resources, contributing to high healthcare costs.
• Optimizing resource utilization in ICUs is crucial for cost containment and efficient patient care.

Purpose of the Study:

• To evaluate the effectiveness of an information-based management system in reducing laboratory resource use and associated costs within adult ICUs.
• To assess the sustainability of these reductions and their impact on patient outcomes.

Main Methods:

• An interventional study with prospective data collection was conducted in a tertiary care hospital's adult surgical and medical ICUs.
• A management database tracked 123 laboratory investigations, with specific policies targeting nine high-frequency tests for reduction.
• Policies were implemented during a 1-year intervention period and monitored over a subsequent 2-year follow-up period.

Main Results:

• A 25% overall reduction in monitored laboratory tests was observed during the intervention period.
• Significant reductions (19-46%) were achieved for the nine targeted tests, with potential annual savings exceeding $150,000 Canadian.
• Reductions were maintained during the 2-year follow-up, with no observed increase in ICU mortality or length of stay.

Conclusions:

• An information-based, multidisciplinary management system effectively reduces unnecessary testing in ICUs in a cost-effective manner.
• Reducing needless testing is a safe and viable cost-containment strategy for intensive care services.
• Sustained reductions in laboratory utilization can be achieved without compromising patient safety or outcomes.