Impact of clinical guidelines to improve appropriateness of laboratory tests and chest radiographs

• Published in: Intensive care medicine Vol. 35; no. 6; pp. 1047 - 1053
• Main Authors: Prat, Gwénaël, Lefèvre, Montaine, Nowak, Emmanuel, Tonnelier, Jean-Marie, Renault, Anne, L’Her, Erwan, Boles, Jean-Michel
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.06.2009; Springer; Springer Nature B.V
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Biological and medical sciences; Clinical Laboratory Techniques - economics; Cost Control; Critical Care Medicine; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Emergency Medicine; Female; France; Hospital Costs; Humans; Intensive; Intensive care medicine; Intensive Care Units; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Original; Pain Medicine; Pediatrics; Pneumology/Respiratory System; Point-of-Care Systems; Practice Guidelines as Topic; Radiography, Thoracic - economics; Retrospective Studies; Unnecessary Procedures - economics; France; Chest radiograph; Practice guideline; Laboratory testing; Healthcare cost control; Quality improvement; Cost savings; Radiography; Costs; Intensive care; Laboratory test; Resuscitation
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-009-1438-z

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.