Duplicate laboratory test reduction using a clinical decision support tool.

OBJECTIVES Duplicate laboratory tests that are unwarranted increase unnecessary phlebotomy, which contributes to iatrogenic anemia, decreased patient satisfaction, and increased health care costs. MATERIALS AND METHODS We employed a clinical decision support tool (CDST) to block unnecessary duplicate test orders during the computerized physician order entry (CPOE) process. We assessed laboratory cost savings after 2 years and searched for untoward patient events associated with this intervention. RESULTS This CDST blocked 11,790 unnecessary duplicate test orders in these 2 years, which resulted in a cost savings of $183,586. There were no untoward effects reported associated with this intervention. CONCLUSIONS The movement to CPOE affords real-time interaction between the laboratory and the physician through CDSTs that signal duplicate orders. These interactions save health care dollars and should also increase patient satisfaction and well-being.

[1]  Anand S Dighe,et al.  Utilization management in a large urban academic medical center: a 10-year experience. , 2011, American journal of clinical pathology.

[2]  K W Kizer,et al.  Geographic variations in utilization rates in Veterans Affairs hospitals and clinics. , 1999, The New England journal of medicine.

[3]  Kent Lewandrowski,et al.  Managing utilization of new diagnostic tests. , 2003, Clinical leadership & management review : the journal of CLMA.

[4]  E. Powell,et al.  Physician variation in test ordering in the management of gastroenteritis in children. , 2003, Archives of pediatrics & adolescent medicine.

[5]  A Robinson,et al.  Rationale for cost-effective laboratory medicine , 1994, Clinical Microbiology Reviews.

[6]  Andrew W. Lyon,et al.  Simulation of repetitive diagnostic blood loss and onset of iatrogenic anemia in critical care patients with a mathematical model , 2013, Comput. Biol. Medicine.

[7]  E. Benson Initiatives toward effective decision making and laboratory use. , 1980, Human pathology.

[8]  D D Bell,et al.  Postoperative laboratory and imaging investigations in intensive care units following coronary artery bypass grafting: a comparison of two Canadian hospitals. , 1998, The Canadian journal of cardiology.

[9]  S. A. Schroeder,et al.  Variation among Physicians in Use of Laboratory Tests II. Relation to Clinical Productivity and Outcomes of Care , 1977, Medical care.

[10]  Jonathan Cylus,et al.  Health spending projections through 2018: recession effects add uncertainty to the outlook. , 2009, Health affairs.

[11]  Zackary Berger,et al.  The "top 5" lists in primary care: meeting the responsibility of professionalism. , 2011, Archives of internal medicine.

[12]  A. Kanitsap,et al.  Approximate iatrogenic blood loss in medical intensive care patients and the causes of anemia. , 2010, Journal of the Medical Association of Thailand = Chotmaihet thangphaet.

[13]  K. Berndtson Managers and physicians come head to head over cost control. , 1986, Healthcare financial management : journal of the Healthcare Financial Management Association.

[14]  H. G. Morgan,et al.  Emergency Biochemistry Services—Are They Abused? , 1982, Annals of clinical biochemistry.