title: Multipronged strategy to reduce routine-priority blood testing in intensive care unit patients.
abstract: OBJECTIVE
  The purpose of the study is to reduce unnecessary ordering of routine-priority blood tests.
  
  
  METHODS
  In this before-after study, we studied all patients admitted to a 15-bed tertiary intensive care unit (ICU) from July 1, 2011, to June 27, 2013. Based on input from intensivists, acceptable indications for ordering routine-priority complete blood counts (CBCs) and electrolyte/renal panels were developed. Sequential interventions were (1) education sessions for ICU housestaff about the lack of evidence for routine-priority blood tests; (2) an item on the ICU rounds checklist to ask if routine-priority blood tests were indicated; (3) a rubber stamp, "routine bloodwork NOT indicated for tomorrow," was used in the chart; (4) a prompt in the electronic ordering system to allow only accepted indications; and (5) a second educational session for ICU housestaff. We measured numbers of tests done before and after these interventions.
  
  
  RESULTS
  After introduction of interventions, there were 0.14 fewer routine-priority CBCs and 0.13 fewer routine-priority electrolyte/renal panels done per patient-day. Nonroutine CBCs and nonroutine electrolyte/renal panels increased by 0.03 and 0.02 tests per patient-day, respectively. This overall reduction in tests equates to an adjusted savings of $11,200.24 over 1 year in 1 ICU. There were no differences in demographics, severity of illness, length of stay, or number of red cell transfusions between the 2 periods.
  
  
  CONCLUSIONS
  Sequential interventions to discourage the ordering of routine-priority blood tests in an ICU were associated with a significant decrease in the number of tests ordered.
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Hayley L
authors.initials: HL
authors.lastname: Merkeley
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Juliya
authors.initials: J
authors.lastname: Hemmett
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Tara A
authors.initials: TA
authors.lastname: Cessford
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Neda
authors.initials: N
authors.lastname: Amiri
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Georgia S
authors.initials: GS
authors.lastname: Geller
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Nazli
authors.initials: N
authors.lastname: Baradaran
authors.affiliation: Center for Health Evaluation and Outcome Sciences, St Paul's Hospital and University of British Columbia, Vancouver, BC, Canada V6Z1Y6.
authors.forename: Monica
authors.initials: M
authors.lastname: Norena
authors.affiliation: Center for Health Evaluation and Outcome Sciences, St Paul's Hospital and University of British Columbia, Vancouver, BC, Canada V6Z1Y6.
authors.forename: Hubert
authors.initials: H
authors.lastname: Wong
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Center for Health Evaluation and Outcome Sciences, St Paul's Hospital and University of British Columbia, Vancouver, BC, Canada V6Z1Y6; Division of Critical Care Medicine, St Paul's Hospital and University of British Columbia, Vancouver, BC, Canada.
authors.forename: Najib
authors.initials: N
authors.lastname: Ayas
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Center for Health Evaluation and Outcome Sciences, St Paul's Hospital and University of British Columbia, Vancouver, BC, Canada V6Z1Y6; Division of Critical Care Medicine, St Paul's Hospital and University of British Columbia, Vancouver, BC, Canada. Electronic address: peter.dodek@ubc.ca.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Dodek
mesh_terms: D000328:Adult; D000368:Aged; D001772:Blood Cell Count / Q000706:statistics & numerical data*; D001774:Blood Chemical Analysis / Q000706:statistics & numerical data*; D003422:Critical Care / Q000379:methods*; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007396:Internship and Residency; D008297:Male; D008505:Medical Staff, Hospital / Q000193:education; D008875:Middle Aged; D058996:Quality Improvement; D062606:Tertiary Care Centers; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*
keywords: Diagnostic tests; Intensive care units; Resource utilization