Optimizing Utilization of Laboratory Investigations in Neonatal Intensive Care Unit
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To optimize utilization of laboratory tests by measuring baseline rates and appropriateness of investigations, assessing the barriers to rational use, and developing and implementing an educational package for resident doctors.
Quality improvement study.
Neonatal intensive care unit (NICU) from August, 2015 to December, 2016.
All neonates admitted in NICU and resident doctors working in NICU.
Addressing barriers, educational package, posters and group discussions.
Main outcome measures
Laboratory test rates for hematology, biochemistry and blood gas. Proportion of tests judged to be inappropriate.
At the baseline, median (IQR) laboratory test rate patient/day was 0.6 (0.2–1.5) and one-fifth of tests were classified as inappropriate. Mechanical ventilation and sepsis were independent predictors of laboratory test rates but could explain only 35% of the disparities, indicating variations in clinical practice. Following a short period of intervention, hematology investigations showed a trend towards reduction, though overall test rates did not change significantly.
Addressing barriers, creating awareness and educational interventions were able to bring down hematology laboratory test rates in a short period. A longer period of sustained intervention is required to demonstrate significant effects on test ordering behavior.
KeywordsBiochemistry Blood gas Hematology Tests
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- 4.Fryer AA, Smellie WSA. Managing demand for laboratory tests: A laboratory toolkit. J Clin Pathol. 2013;66:62–72. WHAT ISALREADY KNOWN? • Inappropriate laboratory investigations increase cost and blood loss, and may lead to more tests and wrong diagnosis, and cause anxiety. WHAT THIS STUDY ADDS? • It is possible to optimize utilization of laboratory tests by addressing local barriers and implementing an educational package.CrossRefPubMedGoogle Scholar
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