Reducing Unnecessary Phlebotomy Testing Using a Clinical Decision Support System

Background: Overuse of phlebotomy testing offers little to improve patient outcomes. Reducing unnecessary phlebotomy tests can cut costs without compromising quality. Purpose: To determine the effectiveness of a clinical decision support system (CDSS) on reducing unnecessary type and screen tests, estimate the cost saved by the CDSS implementation, and describe the unnecessary ordering practices by provider type. Methods: Our study used a separate-sample pretest posttest design at a mid-Atlantic academic medical center to examine the number of unnecessary type and screen tests three months before and after CDSS implementation. A CDSS was embedded in our electronic health record. The CDSS appears when a type and screen is ordered informing the provider of the date and time the current test expires. Cost savings was estimated using time-driven activity-based costing. Pre-intervention (801 tests) and post-intervention (801 tests) periods were used to describe ordering practices by provider type. Results: There were a total of 26,206 pre- and 25,053 post-intervention specimens. Significantly fewer unnecessary type and screen tests were ordered after the intervention (12.3%, n=3,073) than before (14.1%, n=3,691; p\u3c0.001). The results demonstrated an estimated yearly savings of $142,612 after CDSS implementation. The majority of the tests were ordered by physicians (85.3% before and 83.1% after the intervention) compared to advanced practice nurses and physician assistants. Conclusions: Our study demonstrated that a CDSS impacted a variety of provider types, reduced unnecessary phlebotomy tests, and decrease annual costs. Interventions such as education, audits, and feedback are recommended to further reduce unnecessary ordering practices

Reducing Unnecessary Phlebotomy Testing Using a Clinical Decision Support System

Overuse of phlebotomy testing offers little to improve patient outcomes but may subject patients to additional morbidity. Low-cost, high-frequency tests are ordered recurrently, unnecessarily, and contribute to the high cost of health care. Reducing unnecessary phlebotomy tests can cut costs without compromising quality. Type and screen tests are active for three days from the date the specimen is collected, yet our blood bank laboratory observed type and screen tests were often unnecessarily ordered in our organization. We set out to determine the effectiveness of a clinical decision support system (CDSS) on reducing unnecessary type and screen tests, estimate the cost saved by the CDSS implementation, and describe the unnecessary ordering practices by provider type. Adoption of CDSSs has been successful in reducing unnecessary radiologic imaging, overutilization of antibiotics, and Clostridium dificile testing. Our value improvement initiative was a separate-sample pretest posttest design at a mid-Atlantic academic health system. A CDSS was embedded in our computerized order entry (COPE) system to promote appropriate test ordering. The CDSS appears when a type and screen is ordered informing the provider of the date and time the current test expires. Our study demonstrated that CDSSs impacted a variety of provider types, reduced unnecessary phlebotomy tests, and achieved yearly cost savings. Unnecessary testing continues in health care and contributes to excessive health spending without adding value. Phlebotomy testing is one example of how providers can reduce waste and control healthcare costs for low-cost, high-frequency tests. To further improve test ordering practices of all provider types, we recommend additional interventions such as organizational support, education, audits, and feedback. In this era of precision medicine, ordering the right test, at the right time, for the right reason can reduce cost, reduce waste, and improve quality, outcomes, and satisfaction for patients. Until the establishment of national quality measures aimed to control the number of low-cost, high-frequency tests, health systems must find a way to reduce unnecessary health services. CPOE is widely used in a variety of health care settings and can incorporate CDSS to guide all provider types to make judicious decisions at the time of care