Rachakonda K S, Parr M, Aneman A, Bhonagiri S, Micallef S
Senior Staff Specialist, Intensive Care, Liverpool Hospital, Conjoint Senior Lecturer, University of New South Wales, Sydney, New South Wales.
Director of ICU, Intensive Care, Liverpool Hospital, Conjoint Professor, University of New South Wales, Professorial Fellow, The Simpson Centre for Health Services Research, Ingham Institute for Applied Medical Research, Sydney, New South Wales.
Anaesth Intensive Care. 2017 Jul;45(4):503-510. doi: 10.1177/0310057X1704500415.
Blood tests are ordered on a daily basis in intensive care units (ICU). There are no widely accepted guidelines for testing requirements. This study investigated the impact on ICU laboratory test costs of a multi-strategy change in practice involving routine blood testing. A single centre, prospective, interventional study using historical controls was undertaken to investigate the impact of ICU specialist authorisation of high-volume routine tests on ICU laboratory test costs. Prior to commencement of the study, ICU nursing and junior ICU doctors were able to order tests. During the six-month intervention period, the ICU specialists authorised routine blood tests. Adverse events related to not performing blood tests were also recorded. Overall ICU laboratory test costs decreased by 12.3% over the six months (=0.0022 versus historical control) with a mean compliance of 51% with the test authorisation protocol. The costs of frequently ordered tests (classified as high-volume) decreased by 20% (=0.0022 versus historical control). These accounted for an average of 54 ± 3% of the overall ICU blood test costs (blood gas analyses 17%, simple chemistry tests consisting of electrolytes, liver function, calcium, phosphate, magnesium 14%, coagulation 12% and full blood count 11%). Two protocol-related adverse events were recorded and judged as minor and were resolved by ordering tests during the day. No adverse patient outcomes resulted from these two events. Blood testing authorisation by an ICU specialist was associated with significant cost savings in ICU and no adverse patient outcomes.
重症监护病房（ICU）每天都会安排血液检查。目前对于检查要求尚无广泛认可的指南。本研究调查了一项涉及常规血液检查的多策略实践变革对ICU实验室检查成本的影响。采用历史对照进行了一项单中心、前瞻性干预研究，以调查ICU专科医生对大量常规检查进行授权对ICU实验室检查成本的影响。在研究开始前，ICU护士和初级ICU医生可以开具检查单。在为期六个月的干预期内，由ICU专科医生对常规血液检查进行授权。还记录了与未进行血液检查相关的不良事件。在六个月期间，ICU实验室检查总成本下降了12.3%（与历史对照相比，P = 0.0022），对检查授权方案的平均依从率为51%。频繁开具的检查（归类为大量检查）成本下降了20%（与历史对照相比，P = 0.0022）。这些检查平均占ICU总体血液检查成本的54±3%（血气分析17%，包括电解质、肝功能、钙、磷、镁的简单化学检查14%，凝血检查12%，全血细胞计数11%）。记录了两例与方案相关的不良事件，判定为轻微，并通过在白天开具检查得以解决。这两起事件未导致不良患者结局。ICU专科医生进行血液检查授权与ICU显著节省成本相关，且未出现不良患者结局。
