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Impact of clinical guidelines to improve appropriateness of laboratory tests and chest radiographs

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Abstract

Objective

To assess the impact of clinical guidelines to improve appropriate use of routine laboratory tests and bedside chest radiographs in a medical intensive care.

Design

A two-year (Period-1: 2005, Period-2: 2006), retrospective, comparative study, before and after policy implementation.

Patients

All consecutive patients admitted during the study periods.

Setting

A university hospital 15-bed medical ICU.

Intervention

Multifaceted intervention combining a daily routine prescription help-guide developed by a multidisciplinary group and displayed at patient’s bedside, educational sessions and feedbacks by information on volumes of prescription. Individual adaptation to patient’s clinical status was allowed by protocol.

Assessment

The overall number and cost of laboratory tests and chest radiographs during Period-2 (with the help guide; from 01 to 12-2006) were compared to Period-1 (from 01 to 12-2005).

Results

Patients’ general characteristics were similar during the two periods. A relative reduction of routine laboratory tests performance was observed per patient-ICU-day, ranging from 38 to 71.5% depending on the type of tests (P < 0.001 in all cases). For chest radiographs, a 41% relative reduction was observed between the two periods (P < 0.001). Daily ICU laboratory tests and chest radiographs cost per patient decreased from 114 to 56€. An overall 300,000€ ICU cost reduction was directly related to the protocol implementation.

Conclusion

The implementation of a laboratory tests and chest radiographs prescription protocol within our ICU induced an important cost saving.

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References

  1. Merlani P, Garnenin P, Diby M, Ferring M, Ricou B (2001) Quality improvement report: linking guideline to feedback to increase appropriate requests for clinical tests: blood gas analysis in intensive care. BMJ 323:620–624

    Article  PubMed  CAS  Google Scholar 

  2. Alazia M, Colavolpe JC, Botti G, Corda N, Ramero C, François G (1996) Blood loss from diagnostic laboratory tests performed in intensive care units. Preliminary study. Ann Fr Anesth Reanim 15:1004–1007

    PubMed  CAS  Google Scholar 

  3. Vincent JL, Baron JF, Reinhart K, Gattinoni L, Thijs L, Webb A, Meier-Hellmann A, Nollet G, Peres-Bota D, for the ABC investigators (2004) Anemia and blood transfusion in critically ill patients. JAMA 288:1499–1507

    Article  Google Scholar 

  4. Chant C, Wilson G, Friedrich JO (2006) Anemia, transfusion, and phlebotomy practices in critically ill patients with prolonged ICU length of stay: a cohort study. Crit Care 10:R40

    Article  Google Scholar 

  5. Barie PS (2004) Phlebotomy in the intensive care unit: strategies for blood conservation. Crit Care 8:S34–S36

    Article  PubMed  Google Scholar 

  6. Bleland D, D’Angelo C, Vinci D (2003) Reducing unnecessary blood work in the neurosurgical ICU. J Neurosci Nurs 35:149–152

    Google Scholar 

  7. Graat ME, Stoker J, Vroom MB, Scultz MJ (2005) Can we abandon daily routine chest radiography in intensive care patients? J Intensive Care Med 20:238–246

    Article  PubMed  Google Scholar 

  8. Graat ME, Hendrikse KA, Spronk PE, Korevaar JC, Stoker J, Scultz MJ (2006) Chest radiography practice in critically ill patients: a postal survey in the Netherlands. BMC Med Imaging 18:6–8

    Google Scholar 

  9. Graat ME, Choi G, Wolthius EK, Korevaar JC, Spronk PE, Stoker J, Vroom MB, Schultz MJ (2006) The clinical value of daily routine chest radiographs in a mixed medical-surgical intensive care unit is low. Crit Care 10:R11

    Article  PubMed  Google Scholar 

  10. Graat ME, Kröner A, Spronk PE, Korevaar JC, Stoker J, Vroom MB, Scultz MJ (2007) Elimination of daily routine chest radiographs in a mixed medical-surgical intensive care unit. Intensive Care Med 33:639–644

    Article  PubMed  Google Scholar 

  11. Krivopal M, Sholbin O, Schwartzstein R (2003) Utility of daily routine portable chest radiographs in mechanically ventilated patients in the medical ICU. Chest 123:1607–1614

    Article  PubMed  Google Scholar 

  12. Hendrikse KA, Gratama JW, Hove W, Rommes JH, Schultz MJ, Spronk PE (2007) Low value of routine chest radiographs in a mixed medical-surgical ICU. Chest 132:823–828

    Article  PubMed  Google Scholar 

  13. Grol R, Grimshaw J (2003) From best evidence to best practice: effective implementation of change in patients’ care. Lancet 362:1225–1230

    Article  PubMed  Google Scholar 

  14. Grol R (1997) Personal paper. Beliefs and evidence in changing clinical practice. BMJ 315:418–421

    PubMed  CAS  Google Scholar 

  15. Cook DJ, Montori VM, McMullin JP, Finfer SR, Rocker GM (2004) Improving patients’ safety locally: changing clinician behaviour. Lancet 363:1224–1230

    Article  PubMed  CAS  Google Scholar 

  16. Prat G, Jaffuel S, Lefevre M, Renault A, Tonnelier JM, L’Her E, Boles JM (2007) Evaluation of a standardized prescription protocol of routine blood tests and bedside chest X-rays in an ICU: financial impact. ESICM 20th Annual Congress. Intensive Care Med 33:S205–S796

    Google Scholar 

  17. Shaffer C (2007) Diagnostic blood loss in mechanically ventilated patients. Heart Lung 36:217–222

    Article  PubMed  Google Scholar 

  18. Wisser D, Van Ackern K, Knoll E, Wisser H, Bertsch T (2003) Blood loss from laboratory tests. Clin Chem 49:1651–1655

    Article  PubMed  CAS  Google Scholar 

  19. Low LL, Harrington GR, Stoltzfus DP (1995) The effect of arterial lines on blood-drawing practices and costs in the intensive care units. Chest 108:216–219

    Article  PubMed  CAS  Google Scholar 

  20. Cook DJ (1992) Physicians’ perceptions of laboratory costs in the intensive care unit, Hamilton Regional Critical Care Group. Clin Invest Med 15:476–481

    PubMed  CAS  Google Scholar 

  21. Fowler RA, Berenson M (2003) Blood conservation in the intensive care unit. Crit Care Med 31:S715–S720

    Article  PubMed  Google Scholar 

  22. Gonano C, Sitzwohl C, Pusch F, Kettner SC, Weinstabl C, Zimpfer M (2003) Educational or organisation approach: which is more effective in changing blood-sampling habits? Anesth Analg 97:1479–1482

    Article  PubMed  Google Scholar 

  23. Barie PS, Hydo LJ (1996) Learning to not know: results of a program for ancillary cost reduction in surgical critical care. J Trauma 41:714–720

    Article  PubMed  CAS  Google Scholar 

  24. Barie PS, Hydo LJ (1997) Lessons learned: durability and progress of a program for ancillary cost reduction in surgical critical care. J Trauma 43:590–596

    Article  PubMed  CAS  Google Scholar 

  25. Marx WH, DeMaintenon NL, Mooney KF, Mascia ML, Medicis J, Franklin PD, Sivak E, Rotello L (1999) Cost reduction and outcome improvement in the intensive care unit. J Trauma 46:625–629

    Article  PubMed  CAS  Google Scholar 

  26. Calderon-Margalit R, Mor-Yosef S, Mayer M, Adler B, Shapira SC (2005) An administrative intervention to improve the utilization of laboratory tests within university hospital. Int J Qual Health Care 17:243–248

    Article  PubMed  Google Scholar 

  27. Perbet S, Lagneau F, Wernet A, Delefosse D, Belghiti J, Marty J (2007) Incidence of biological tests required outside of written medical prescriptions in digestive surgical intensive care unit. Ann Fr Anesth Reanim 26:1037–1040

    PubMed  CAS  Google Scholar 

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Correspondence to Gwénaël Prat.

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Prat, G., Lefèvre, M., Nowak, E. et al. Impact of clinical guidelines to improve appropriateness of laboratory tests and chest radiographs. Intensive Care Med 35, 1047–1053 (2009). https://doi.org/10.1007/s00134-009-1438-z

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  • DOI: https://doi.org/10.1007/s00134-009-1438-z

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