Major reductions in unnecessary aspartate aminotransferase and blood urea nitrogen tests with a quality improvement initiative
| Autor: | Alex M. Cressman, Mark Cheung, Alireza Zahirieh, Suzanne Waldman, Edward Etchells, Rachel Strauss, Jeremy Rezmovitz, Jeannie Callum, Adina Weinerman, Piero Tartaro |
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| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Canada Advisory Committees Context (language use) Bed days Medical Overuse Medical Order Entry Systems Blood Urea Nitrogen Tertiary Care Centers 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Internal medicine Medicine Humans 030212 general & internal medicine Aspartate Aminotransferases Blood urea nitrogen Hospital days Creatinine Absolute number business.industry Diagnostic Tests Routine 030503 health policy & services Health Policy Alanine Transaminase Quality Improvement Patient management Cost savings chemistry Practice Guidelines as Topic 0305 other medical science business |
| Zdroj: | BMJ qualitysafety. 28(10) |
| ISSN: | 2044-5423 |
| Popis: | Background/contextUnnecessary laboratory testing leads to considerable healthcare costs. Aspartate aminotransferase (AST), commonly ordered with alanine aminotransferase (ALT) and blood urea nitrogen (BUN), commonly ordered with creatinine (Cr), often add little value to patient management at significant cost. We undertook a choosing wisely based quality improvement initiative to reduce the frequency of testing.ObjectivesTo reduce the ratio of AST/ALT and BUN/Cr to less than 5% for all inpatient and outpatient test orders.MeasuresAbsolute number and ratio of AST/ALT and BUN/Cr; AST, ALT, BUN and Cr tests per 100 hospital days; projected annualised cost savings and monthly acute inpatient bed days.ImprovementsWe created guidelines for appropriate indications of AST and BUN testing, provided education with audit and feedback and removed AST and BUN from institutional order sets.Impact/resultsThe ratios of AST/ALT and BUN/Cr decreased significantly over the study period (0.37 to 0.14, 0.57 to 0.14, respectively), although the goal of 0.05 was not achieved due to a delay in adopting the choosing wisely strategies during the study time period by some inpatient units. The number of tests per 100 hospital days decreased from 20 to 7 AST (95% CI 19 to 20.5, 5.6 to 8.7, pDiscussionA significant decrease in the AST/ALT and BUN/Cr ratios can be achieved with a multimodal approach and will result in substantial healthcare savings. |
| Databáze: | OpenAIRE |
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