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Impact of clinical guidelines to improve appropriateness of laboratory tests and chest radiographs.
Intensive Care Med. 2009 Feb 17;
Authors: Prat G, Lefèvre M, Nowak E, Tonnelier JM, Renault A, L'her E, Boles JM
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.
PMID: 19221715 [PubMed - as supplied by publisher]
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