title: [How can we optimize medical orderings in intensive care unit (ICU)?].
abstract: OBJECTIVE
  To evaluate whether intensivists would accept to optimize their orderings of biological samplings, x-rays and target drugs and to assess the consequence on patient's outcome.
  
  
  METHODS
  Monocentric evaluation of medical economic procedure.
  
  
  METHODS
  Meetings of consultants, registrars and residents started on Dec 21, 2006 with two to three sessions a year in order to evaluate the process of medical ordering. The physicians and pharmacists gave the results of orderings at each meeting. Orderings of systematic samplings, bedside x-rays and unjustified expansive drugs were discouraged, but target samplings and lung ultrasonography were encouraged. New residents were systematically taught about this programme. Meanwhile, monthly morbidity-mortality meetings were pursued in order to assess the consequences of this politics.
  
  
  RESULTS
  While ICU total production increased by 3.4% and potentially evitable deaths decreased by 34%, annual expenses decreased by approximatively € 777,000 from 2006 to 2008. This was due to decreased orderings in biology by 30%, bedside x-rays by 10%, computed tomographic scans by 16% and target drugs by 35%. However, an increased ordering in four target drugs was observed in 2008 as compared with 2007.
  
  
  CONCLUSIONS
  Multidisciplinary optimization of medical ordering can be efficient in ICU. However, a profit-sharing with ordering physicians would be necessary to prolong these effects.
authors: Service d'anesthésie-réanimation, hôpital Louis-Pradel, groupement hospitalier Est, hospices civils de Lyon, 28 avenue du Doyen-Lépine, Bron, France. jean-jacques.lehot@chu-lyon.fr
authors: J-J
authors: JJ
authors: Lehot
authors: C
authors: C
authors: Heuclin
authors: J
authors: J
authors: Neidecker
authors: R
authors: R
authors: Cartier
authors: P
authors: P
authors: Ffrench
authors: M E
authors: ME
authors: Reverdy
authors: D
authors: D
authors: Revel
authors: M
authors: M
authors: Billard
authors: C
authors: C
authors: Lupo
authors: B
authors: B
authors: Gonnard
authors: G
authors: G
authors: Keller
authors: G
authors: G
authors: Aulagner
authors: O
authors: O
authors: Bastien
mesh_terms: D005240:Feasibility Studies; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D050316:Medical Order Entry Systems / Q000592:standards*