title: Impact of clinical guidelines to improve appropriateness of laboratory tests and chest radiographs.
abstract: OBJECTIVE
  To assess the impact of clinical guidelines to improve appropriate use of routine laboratory tests and bedside chest radiographs in a medical intensive care.
  
  
  METHODS
  A two-year (Period-1: 2005, Period-2: 2006), retrospective, comparative study, before and after policy implementation.
  
  
  METHODS
  All consecutive patients admitted during the study periods.
  
  
  METHODS
  A university hospital 15-bed medical ICU.
  
  
  METHODS
  Multifaceted intervention combining a daily routine prescription help-guide developed by a multidisciplinary group and displayed at patient's bedside, educational sessions and feedbacks by information on volumes of prescription. Individual adaptation to patient's clinical status was allowed by protocol.
  
  
  RESULTS
  The overall number and cost of laboratory tests and chest radiographs during Period-2 (with the help guide; from 01 to 12-2006) were compared to Period-1 (from 01 to 12-2005).
  
  
  RESULTS
  Patients' general characteristics were similar during the two periods. A relative reduction of routine laboratory tests performance was observed per patient-ICU-day, ranging from 38 to 71.5% depending on the type of tests (P < 0.001 in all cases). For chest radiographs, a 41% relative reduction was observed between the two periods (P < 0.001). Daily ICU laboratory tests and chest radiographs cost per patient decreased from 114 to 56 euros. An overall 300,000 euros ICU cost reduction was directly related to the protocol implementation.
  
  
  CONCLUSIONS
  The implementation of a laboratory tests and chest radiographs prescription protocol within our ICU induced an important cost saving.
authors.affiliation: Réanimation Médicale, Pôle Vasculaire-Urgences, Centre Hospitalier Universitaire de Cavale Blanche, Bd Tanguy Prigent, 29609 Brest Cedex, France. gwenael.prat@chu-brest.fr
authors.forename: Gwénaël
authors.initials: G
authors.lastname: Prat
authors.forename: Montaine
authors.initials: M
authors.lastname: Lefèvre
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Nowak
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Tonnelier
authors.forename: Anne
authors.initials: A
authors.lastname: Renault
authors.forename: Erwan
authors.initials: E
authors.lastname: L'Her
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Boles
mesh_terms: D000328:Adult; D000368:Aged; D019411:Clinical Laboratory Techniques / Q000191:economics*; D003363:Cost Control; D005260:Female; D005602:France; D017721:Hospital Costs; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D017410:Practice Guidelines as Topic; D013902:Radiography, Thoracic / Q000191:economics*; D012189:Retrospective Studies; D019564:Unnecessary Procedures / Q000191:economics*