title: Use of a Checklist and Clinical Decision Support Tool Reduces Laboratory Use and Improves Cost.
abstract: OBJECTIVE
  We hypothesized that a daily rounding checklist and a computerized order entry (CPOE) rule that limited the scheduling of complete blood cell counts and chemistry and coagulation panels to a 24-hour interval would reduce laboratory utilization and associated costs.
  
  
  METHODS
  We performed a retrospective analysis of these initiatives in a pediatric cardiovascular ICU (CVICU) that included all patients with congenital or acquired heart disease admitted to the cardiovascular ICU from September 1, 2008, until April 1, 2011. Our primary outcomes were the number of laboratory orders and cost of laboratory orders. Our secondary outcomes were mortality and CVICU and hospital length of stay.
  
  
  RESULTS
  We found a reduction in laboratory utilization frequency in the checklist intervention period and additional reduction in the CPOE intervention period [complete blood count: 31% and 44% (P < .0001); comprehensive chemistry panel: 48% and 72% (P < .0001); coagulation panel: 26% and 55% (P < .0001); point of care blood gas: 43% and 44% (P < .0001)] compared with the preintervention period. Projected yearly cost reduction was $717,538.8. There was no change in adjusted mortality rate (odds ratio 1.1, 95% confidence interval 0.7-1.9, P = .65). CVICU and total length of stay (days) was similar in the pre- and postintervention periods.
  
  
  CONCLUSIONS
  Use of a daily checklist and CPOE rule reduced laboratory resource utilization and cost without adversely affecting adjusted mortality or length of stay. CPOE has the potential to hardwire resource management interventions to augment and sustain the daily checklist.
authors.affiliation: Division of Pediatric Cardiology.
authors.forename: Claudia A
authors.initials: CA
authors.lastname: Algaze
authors.affiliation: Center for Quality and Clinical Effectiveness.
authors.forename: Matthew
authors.initials: M
authors.lastname: Wood
authors.affiliation: Division of Systems Medicine, and Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Natalie M
authors.initials: NM
authors.lastname: Pageler
authors.affiliation: Center for Quality and Clinical Effectiveness, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Sharek
authors.affiliation: Division of Systems Medicine, and Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Longhurst
authors.affiliation: Division of Pediatric Cardiology, drewshin@stanford.edu.
authors.forename: Andrew Y
authors.initials: AY
authors.lastname: Shin
mesh_terms: D057189:Checklist; D002648:Child; D002675:Child, Preschool; D020000:Decision Support Systems, Clinical; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007753:Laboratories / Q000191:economics* / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D050316:Medical Order Entry Systems; D019564:Unnecessary Procedures / Q000191:economics*