Are Daily Blood Draws Necessary? Impact of Provider Education on the Frequency of Daily Blood Test Ordered in Hospitalized Patients

1Johns Hopkins University School of Medicine, Clarksville, MD
2Johns Hopkins University, Baltimore, MD
3Johns Hopkins University School of Medicine, Baltimore, MD

Meeting: Hospital Medicine 2014, March 24-27, Las Vegas, Nev.

Abstract number: 140

Background:

Hospital admission usually leads to blood draw for diagnostic laboratory tests which can help in patient care. Providers routinely order daily blood tests including complete blood count, basic metabolic panel or comprehensive metabolic panel and coagulation panel in hospitalized patients even in the face of clinical and laboratory stability. Blood draw is invasive and can be painful and uncomfortable. Studies have shown that excessive blood draw from laboratory testing can contribute to hospital acquired anemia which, in turn can lead to adverse outcome in patient with cardiorespiratory disease. It can also contribute to the soaring healthcare and hospital cost. Our hypothesis was that some daily blood tests are not necessary, and can be avoided. We conducted this study to determine the effect of intervention through provider education on the frequency of daily blood tests ordered in hospitalized patients.

Methods:

This prospective study was approved by the Institutional Review Board. Medicine providers and nursing staffs in an academic hospital were educated through one month intervention. Flyers were displayed in provider’s offices and periodic e‐mail communications were sent reminding them to order daily blood tests only if it will help or change patient care. Patients, 18 and older admitted to general medicine service and had atleast one routine blood test during the hospital stay were included in the study. Two months pre‐intervention data from 1132 patients and post‐intervention data from 996 patients were collected using computerized physician order entry (CPOE) system and analyzed.

Results:

The primary outcome measured was change in the frequency of daily blood tests ordered. Secondary outcome included length of stay and hospital mortality. The results are summarized in table 1.

Mean number of blood tests ordered per patient per day*



Blood tests Pre‐intervention Post‐intervention Percent change P‐value
Complete blood count 1.52 1.36 ‐10.2 <0.001
Basic metabolic panel 0.94 0.82 ‐13.4 <0.001
Complete metabolic panel 0.64 0.62 ‐4.4 0.1424
Prothrombin time 0.62 0.48 ‐22.2 <0.001
Partial thromboplastin time 0.55 0.41 ‐25.1 <0.001
*Derived from mean number of test divided by mean length of stay
There were no statistically significant differences noted in length of stay and hospital mortality in two groups. Cost data analysis showed significant variable cost reduction based on decreased number of tests ordered.

Conclusions:

Our study showed that simple intervention in the form of provider education can be an important tool to reduce the frequency of daily blood test orders in hospitalized patients which may lead to significant cost saving for hospitals.

To cite this abstract:

Thakkar 2, Kim D, Riedel S. Are Daily Blood Draws Necessary? Impact of Provider Education on the Frequency of Daily Blood Test Ordered in Hospitalized Patients. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 140. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/are-daily-blood-draws-necessary-impact-of-provider-education-on-the-frequency-of-daily-blood-test-ordered-in-hospitalized-patients/. Accessed August 24, 2019.

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