title: Use of a mildly restrictive administrative protocol to reduce orders for manual blood film examination from the emergency department.
abstract: In order to conserve laboratory resources, we instituted a mildly restrictive administrative protocol requiring a telephone request by emergency physicians or their designees in order to obtain a manual blood film examination (BFE). This test includes a manual differential leukocyte count (DLC), examination of red cell morphology, and platelet estimate. The protocol resulted in a marked reduction of the number of BFE's performed on emergency department patients from the previous level of one for every complete blood count (CBC). Retrospective chart review of a sample of patients not receiving manual BFEs indicated no apparent adverse effect on patient care. We speculate that the availability of an electronic partial differential count, providing enumeration of lymphocytes and neutrophils along with the CBC, facilitated in part the reduced ordering of manual BFEs.
authors.affiliation: Department of Pathology, University of Maryland Medical School and Hospital, Baltimore 21201.
authors.forename: B B
authors.initials: BB
authors.lastname: Edelman
authors.forename: G A
authors.initials: GA
authors.lastname: Groleau
authors.forename: R A
authors.initials: RA
authors.lastname: Barish
mesh_terms: D015142:Baltimore; D001772:Blood Cell Count / Q000379:methods; D003955:Diagnostic Tests, Routine / Q000592:standards; D004636:Emergency Service, Hospital / Q000191:economics / Q000458:organization & administration*; D006785:Hospitals, University / Q000458:organization & administration; D006801:Humans; D007958:Leukocyte Count