Abstract：
OBJECTIVE: National societies recommend against performing routine daily laboratory testing without a specific indication. Unnecessary testing can lead to patient harm, such as hospital-acquired anemia. The objective of this study was to reduce repeat complete blood counts (CBCs) after initial testing.
METHODS: This was a quality improvement initiative implemented across 11 safety net hospitals in New York City. A best practice advisory (BPA) was implemented that asked the user to remove a CBC if the last 2 CBCs within 72 hours had normal white blood cell and platelet counts and unchanged hemoglobin levels. The outcome measure was the rate of CBCs per 1000 patient days preintervention (January 8, 2020, to December 22, 2020) to postintervention (December 23, 2020, to December 7, 2021). The process measure was the acceptance rate of the BPA, defined as the number of times the repeat CBC order was removed through the BPA divided by the total number of times the BPA triggered.
RESULTS: Across 11 hospitals, repeat CBC testing decreased by 12.3% (73.05 to 64.04 per 1000 patient days, P < .001). Six of the 11 hospitals exhibited statistically significant decreases, ranging from a 10% to 48.9% decrease of repeat CBCs. The overall BPA action rate was 20.0% (24,029 of 119,944 repeat CBCs).
CONCLUSIONS: This low-effort, electronic health record-based intervention can effectively reduce unnecessary laboratory testing.
METHODS: This was a quality improvement initiative implemented across 11 safety net hospitals in New York City. A best practice advisory (BPA) was implemented that asked the user to remove a CBC if the last 2 CBCs within 72 hours had normal white blood cell and platelet counts and unchanged hemoglobin levels. The outcome measure was the rate of CBCs per 1000 patient days preintervention (January 8, 2020, to December 22, 2020) to postintervention (December 23, 2020, to December 7, 2021). The process measure was the acceptance rate of the BPA, defined as the number of times the repeat CBC order was removed through the BPA divided by the total number of times the BPA triggered.
RESULTS: Across 11 hospitals, repeat CBC testing decreased by 12.3% (73.05 to 64.04 per 1000 patient days, P < .001). Six of the 11 hospitals exhibited statistically significant decreases, ranging from a 10% to 48.9% decrease of repeat CBCs. The overall BPA action rate was 20.0% (24,029 of 119,944 repeat CBCs).
CONCLUSIONS: This low-effort, electronic health record-based intervention can effectively reduce unnecessary laboratory testing.
摘要：
目的：国家协会建议不要在没有具体适应症的情况下进行常规的日常实验室检测。不必要的测试会导致病人的伤害，如医院获得性贫血。这项研究的目的是减少初始测试后的重复全血细胞计数（CBC）。
方法：这是一项在纽约市11家安全网医院实施的质量改进计划。实施了最佳实践咨询（BPA），要求用户在72小时内的最后2个CBCs具有正常的白细胞和血小板计数以及不变的血红蛋白水平的情况下去除CBC。结果指标是干预前（2020年1月8日至2020年12月22日）至干预后（2020年12月23日至2021年12月7日）每1000个患者日的CBCs比率。过程测量是BPA的接受率，定义为通过BPA去除重复CBC顺序的次数除以BPA触发的总次数。
结果：在11家医院，重复CBC检测下降了12.3%(每1000名患者天73.05至64.04,P<.001)。11家医院中有6家表现出统计学上的显着下降，重复CBCs减少10%至48.9%。总体BPA作用率为20.0%(119,944次重复CBCs中的24,029次)。
结论：这种低努力，基于电子健康记录的干预可以有效减少不必要的实验室检测。
方法：这是一项在纽约市11家安全网医院实施的质量改进计划。实施了最佳实践咨询（BPA），要求用户在72小时内的最后2个CBCs具有正常的白细胞和血小板计数以及不变的血红蛋白水平的情况下去除CBC。结果指标是干预前（2020年1月8日至2020年12月22日）至干预后（2020年12月23日至2021年12月7日）每1000个患者日的CBCs比率。过程测量是BPA的接受率，定义为通过BPA去除重复CBC顺序的次数除以BPA触发的总次数。
结果：在11家医院，重复CBC检测下降了12.3%(每1000名患者天73.05至64.04,P<.001)。11家医院中有6家表现出统计学上的显着下降，重复CBCs减少10%至48.9%。总体BPA作用率为20.0%(119,944次重复CBCs中的24,029次)。
结论：这种低努力，基于电子健康记录的干预可以有效减少不必要的实验室检测。
