Frequency of Appropriate Laboratory Utilization in an Academic Medical Center: Opportunities for Cost Savings?

1University of Colorado Health and Sciences Center at Denver, Denver, CO
2University of Colorado Health and Sciences Center at Denver, Denver, CO
3University of Colorado Health and Sciences Center at Denver and Denver VA Medical Center, Denver, CO
4University of Colorado Health and Sciences Center at Denver, Denver, CO

Meeting: Hospital Medicine 2008, April 3-5, San Diego, Calif.

Abstract number: 76

Background:

As health care expenditures in the United States take an ever‐expanding piece of the U.S. economy, the contribution of “little‐ticket” items such as common lab tests is being explored. Magnesium (Mg) and phosphorus (Phos) are 2 of the 4 most commonly ordered tests at the University of Colorado Hospital. In academic year 2007 approximately $900,000 worth of Mg and Phos tests were ordered. Both tests are ordered as individual labs, instead of multipoint panels, represent a large cumulative annual expenditure, and are easily assessed for appropriateness, thus serving as markers of effective resource utilization.

Methods:

We reviewed Mg and Phos tests from admission through day 3 of 188 adult admissions to the general medical resident services during the first 8 days of each of 5 consecutive months. Appropriateness criteria were developed from published literature, and local consensus and individual tests were retrospectively compared to these standards. On admission, labs ordered to uncover a diagnosis or clinical manifestation associated with altered Mg or Phos were deemed appropriate. On follow‐up, labs ordered to follow a previously abnormal test, treatment of Mg or Phos perturbation, new diagnosis or clinical manifestation associated with altered Mg or Phos were considered appropriate.

Results:

One hundred and eighty‐eight patient charts were reviewed. Six hundred and seventy‐six Mg and Phos labs were ordered (351 Mg and 325 Phos) — 190 on admission and 486 in follow‐up. The percentage of patients with Mg or Phos ordered by day and the percentage ordered appropriately by day are shown in Tables 1 and 2. Overall, 24% of Mg and Phos tests were ordered appropriately. Approximately half the patients had both a Mg and a Phos ordered on admission, day 1, and day 2. Mg and Phos tests after admission were less likely to be appropriate compared to Mg (35% vs. 12%, P < .0001) and Phos (46% vs. 24%, P < .001) ordered on admission. If applied to all hospital Mg and Phos orders, the potential cost of inappropriate Mg and Phos testing totals approximately $685,000 annually.

Table 1. Frequency and Appropriateness of Phosphorus Testing

Table 2. Frequency and Appropriateness of Magnesium Testing

Conclusions:

The great majority of patients received Mg and Phos testing, and more than 75% of these tests were ordered inappropriately. Continued testing after admission was common with the vast majority of testing inappropriate. Appropriate use of little‐ticket health care expenditures such as common laboratory tests represents a significant opportunity for cost savings.

Author Disclosure:

C. Stickrath, none; G. Misky, none; A. Prochazka, none; J. Glasheen, Sanofi, Amgen, consulting.

To cite this abstract:

Stickrath C, Misky G, Prochazka A, Glasheen J. Frequency of Appropriate Laboratory Utilization in an Academic Medical Center: Opportunities for Cost Savings?. Abstract published at Hospital Medicine 2008, April 3-5, San Diego, Calif. Abstract 76. https://www.shmabstracts.com/abstract/frequency-of-appropriate-laboratory-utilization-in-an-academic-medical-center-opportunities-for-cost-savings/. Accessed December 10, 2018.

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