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Indian Pediatrics

, Volume 55, Issue 9, pp 784–787 | Cite as

Optimizing Utilization of Laboratory Investigations in Neonatal Intensive Care Unit

  • Sowmya Devarapalli
  • Shiv Sajan Saini
  • Venkataseshan Sundaram
  • Praveen KumarEmail author
Research Paper
  • 16 Downloads

Abstract

Objective

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.

Design

Quality improvement study.

Setting

Neonatal intensive care unit (NICU) from August, 2015 to December, 2016.

Participants

All neonates admitted in NICU and resident doctors working in NICU.

Intervention

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.

Results

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.

Conclusions

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.

Keywords

Biochemistry Blood gas Hematology Tests 

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References

  1. 1.
    Kwok J, Jones B. Unnecessary repeat requesting of tests: An audit in a government hospital immunology laboratory. J Clin Pathol. 2005;58:457–62.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Zhi M, Ding EL, Theisen-Toupal J, Whelan J, Arnaout R. The landscape of inappropriate laboratory testing: A 15–year meta-analysis. PLoS One. 2013;8:e78962.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Konger RL, Ndekwe P, Jones G, Schmidt RP, Trey M, Baty EJ, et al. Reduction in unnecessary clinical laboratory testing through utilization management at a US government veterans affairs hospital. Am J Clin Pathol. 2016;145:355–64.CrossRefPubMedGoogle Scholar
  4. 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
  5. 5.
    Krasowski MD, Chudzik D, Dolezal A, Steussy B, Gailey MP, Koch B, et al. Promoting improved utilization of laboratory testing through changes in an electronic medical record: Experience at an academic medical center. BMC Med Inform Decis Mak. 2015;15:11.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    National Institute for Health and Care Excellence (NICE). Cost-saving Guidance. Available from: https://doi.org/www.nice.org.uk/about/what-we-do/into-practice/costsaving-guidance. Accessed November 16, 2017.
  7. 7.
    Morden NE, Colla CH, Sequist TD, Rosenthal MB. Choosing wisely–The politics and economics of labeling low-value services. N Engl J Med. 2014;370:589–92.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Kobewka DM, Ronksley PE, McKay JA, Forster AJ, van Walraven C. Influence of educational, audit and feedback, system based, and incentive and penalty interventions to reduce laboratory test utilization: A systematic review. Clin Chem Lab Med. 2015;53:157–83.CrossRefPubMedGoogle Scholar
  9. 9.
    Cetinkaya M, Köksal N, Özkan H. A new scoring system for evaluation of multiple organ dysfunction syndrome in premature infants. Am J Crit Care. 2012;21:328–37.CrossRefPubMedGoogle Scholar
  10. 10.
    Robinson A. Rationale for cost-effective laboratory medicine. Clin Microbiol Rev. 1994;7:185–99.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Ullman AJ, Keogh S, Coyer F, Long DA, New K, Rickard CM. “True Blood” The critical care story: An audit of blood sampling practice across three adult, paediatric and neonatal intensive care settings. Aust Crit Care. 2016;29:90–5.CrossRefPubMedGoogle Scholar
  12. 12.
    Merlani P, Garnerin P, Diby M, Ferring M, Ricou B. Quality improvement report: Linking guideline to regular feedback to increase appropriate requests for clinical tests: Blood gas analysis in intensive care. BMJ. 2001;323:620–4.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Merkeley HL, Hemmett J, Cessford TA, Amiri N, Geller GS, Baradaran N, et al. Multipronged strategy to reduce routine-priority blood testing in intensive care unit patients. J Crit Care. 2016;31:212–6.CrossRefPubMedGoogle Scholar

Copyright information

© Indian Academy of Pediatrics 2018

Authors and Affiliations

  • Sowmya Devarapalli
    • 1
  • Shiv Sajan Saini
    • 1
  • Venkataseshan Sundaram
    • 1
  • Praveen Kumar
    • 1
    Email author
  1. 1.Division of Neonatology, Department of PediatricsPGIMERChandigarhIndia

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