A utilization management intervention to reduce unnecessary testing in the coronary care unit.
BACKGROUND
There have been no studies of interventions to reduce test utilization in the coronary care unit.


OBJECTIVE
To determine whether a 3-part intervention in a coronary care unit could decrease utilization without affecting clinical outcomes.


METHODS
Practice guidelines for routine laboratory and chest radiographic testing were developed by a multidisciplinary team, using evidence-based recommendations when possible and expert opinion otherwise. These guidelines were incorporated into the computer admission orders for the coronary care unit at a large teaching hospital, and educational efforts were targeted at the house staff and nurses. Utilization during the 3-month intervention period was compared with utilization during the same 3 months in the prior year. The hospital's medical intensive care unit, which did not receive the specific intervention, provided control data.


RESULTS
During the intervention period, there were significant reductions in utilization of all chemistry tests (from 7% to 40%). Reductions in ordering of complete blood counts, arterial blood gas tests, and chest radiographs were not statistically significant. After controlling for trends in the control intensive care unit, however, the reductions in arterial blood gas tests (P =.04) and chest radiographs (P<.001) became significant. The reductions in potassium, glucose, calcium, magnesium, and phosphorus testing, but not other chemistries, remained significant. The estimated reduction in expenditures for "routine" blood tests and chest radiographs was 17% (P<.001). There were no significant changes in length of stay, readmission to intensive care, hospital mortality, or ventilator days.


CONCLUSIONS
The utilization management intervention was associated with significant reductions in test ordering without a measurable change in clinical outcomes.
Massachusetts General Hospital, Wang Ambulatory Care Center 478, 15 Parkman St, Boston, MA 02114, USA. mfifer@partners.org
Thomas J
TJ
Wang
Elizabeth A
EA
Mort
Paul
P
Nordberg
Yuchiao
Y
Chang
Mary E
ME
Cadigan
Laura
L
Mylott
Lillian V
LV
Ananian
B Taylor
BT
Thompson
Michael
M
Fessler
William
W
Warren
Amy
A
Wheeler
Mark
M
Jordan
Michael A
MA
Fifer
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000720:Ancillary Services, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D001784:Blood Gas Analysis / Q000706:statistics & numerical data; D001900:Boston; D003325:Coronary Care Units / Q000191:economics / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000175:diagnosis* / Q000191:economics; D003955:Diagnostic Tests, Routine / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D005568:Forms and Records Control; D006784:Hospitals, Teaching / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D015397:Program Evaluation; D011787:Quality of Health Care; D011859:Radiography / Q000706:statistics & numerical data; D013997:Time Factors; D017749:Total Quality Management; D014481:United States; D019564:Unnecessary Procedures; D014600:Utilization Review