title: Embedding time-limited laboratory orders within computerized provider order entry reduces laboratory utilization.
abstract: OBJECTIVE
  To test the hypothesis that limits on repeating laboratory studies within computerized provider order entry decrease laboratory utilization.
  
  
  METHODS
  Cohort study with historical controls.
  
  
  METHODS
  A 20-bed PICU in a freestanding, quaternary care, academic children's hospital.
  
  
  METHODS
  This study included all patients admitted to the pediatric ICU between January 1, 2008, and December 31, 2009. A total of 818 discharges were evaluated prior to the intervention (January 1, 2008, through December 31, 2008) and 1,021 patient discharges were evaluated postintervention (January 1, 2009, through December 31, 2009).
  
  
  METHODS
  A computerized provider order entry rule limited the ability to schedule repeating complete blood cell counts, chemistry, and coagulation studies to a 24-hour interval in the future. The time limit was designed to ensure daily evaluation of the utility of each test.
  
  
  RESULTS
  Initial analysis with t tests showed significant decreases in tests per patient day in the postintervention period (complete blood cell counts: 1.5 ± 0.1 to 1.0 ± 0.1; chemistry: 10.6 ± 0.9 to 6.9 ± 0.6; coagulation: 3.3 ± 0.4 to 1.7 ± 0.2; p < 0.01, all variables vs. preintervention period). Even after incorporating a trend toward decreasing laboratory utilization in the preintervention period into our regression analysis, the intervention decreased complete blood cell counts (p = 0.007), chemistry (p = 0.049), and coagulation (p = 0.001) tests per patient day.
  
  
  CONCLUSIONS
  Limits on laboratory orders within the context of computerized provider order entry decreased laboratory utilization without adverse affects on mortality or length of stay. Broader application of this strategy might decrease costs, the incidence of iatrogenic anemia, and catheter-associated bloodstream infections.
authors: Center for Excellence in Pulmonary Biology Divisions of Pulmonary, Asthma and Critical Care Medicine, Stanford, CA, USA. npageler@stanford.edu
authors: Natalie M
authors: NM
authors: Pageler
authors: Deborah
authors: D
authors: Franzon
authors: Christopher A
authors: CA
authors: Longhurst
authors: Matthew
authors: M
authors: Wood
authors: Andrew Y
authors: AY
authors: Shin
authors: Eloa S
authors: ES
authors: Adams
authors: Eric
authors: E
authors: Widen
authors: David N
authors: DN
authors: Cornfield
mesh_terms: D001772:Blood Cell Count / Q000706:statistics & numerical data; D001774:Blood Chemical Analysis / Q000706:statistics & numerical data; D001780:Blood Coagulation Tests / Q000706:statistics & numerical data; D002648:Child; D015331:Cohort Studies; D019091:Critical Pathways / Q000458:organization & administration*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration*; D007755:Laboratories, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D050316:Medical Order Entry Systems; D010818:Practice Patterns, Physicians'; D013997:Time Factors; D019564:Unnecessary Procedures / Q000191:economics / Q000706:statistics & numerical data