May Todd A, Clancy Mary, Critchfield Jeff, Ebeling Fern, Enriquez Anita, Gallagher Carmel, Genevro Jim, Kloo Jay, Lewis Paul, Smith Rita, Ng Valerie L
Department of Family and Community Medicine, School of Medicine, University of California San Francisco, CA, USA.
Am J Clin Pathol. 2006 Aug;126(2):200-6. doi: 10.1309/WP59-YM73-L6CE-GX2F.
After an inpatient phlebotomy-laboratory test request audit for 2 general inpatient wards identified 5 tests commonly ordered on a recurring basis, a multidisciplinary committee developed a proposal to minimize unnecessary phlebotomies and laboratory tests by reconfiguring the electronic order function to limit phlebotomy-laboratory test requests to occur singly or to recur within one 24-hour window. The proposal was implemented in June 2003. Comparison of fiscal year volume data from before (2002-2003) and after (2003-2004) implementation revealed 72,639 (12.0%) fewer inpatient tests, of which 41,765 (57.5%) were related directly to decreases in the 5 tests frequently ordered on a recurring basis. Because the electronic order function changes did not completely eliminate unnecessary testing, we concluded that the decrease in inpatient testing represented a minimum amount of unnecessary inpatient laboratory tests. We also observed 17,207 (21.4%) fewer inpatient phlebotomies, a decrease sustained in fiscal year 20042005. Labor savings allowed us to redirect phlebotomists to our understaffed outpatient phlebotomy service.
在对两个普通住院病房的住院静脉采血-实验室检查申请进行审核后，发现有5项检查经常被重复开具。一个多学科委员会提出了一项建议，通过重新配置电子医嘱功能，将静脉采血-实验室检查申请限制为单次申请或在一个24小时窗口内重复申请，以尽量减少不必要的静脉采血和实验室检查。该建议于2003年6月实施。对实施前（2002 - 2003年）和实施后（2003 - 2004年）财年的检查量数据进行比较发现，住院检查减少了72,639项（12.0%），其中41,765项（57.5%）直接与经常重复开具的5项检查的减少有关。由于电子医嘱功能的改变并未完全消除不必要的检查，我们得出结论，住院检查的减少代表了不必要的住院实验室检查的最低数量。我们还观察到住院静脉采血减少了17,207次（21.4%），这一减少在2004 - 2005财年持续存在。节省的人力使我们能够将采血人员重新分配到人员不足的门诊采血服务部门。
