Rudolf Joseph W, Dighe Anand S, Coley Christopher M, Kamis Irina K, Wertheim Bradley M, Wright Douglas E, Lewandrowski Kent B, Baron Jason M
Departments of Pathology.
Harvard Medical School, Boston, MA.
Am J Clin Pathol. 2017 Aug 1;148(2):128-135. doi: 10.1093/ajcp/aqx054.
We sought to address concerns regarding recurring inpatient laboratory test order practices (daily laboratory tests) through a multifaceted approach to changing ordering patterns.
We engaged in an interdepartmental collaboration to foster mindful test ordering through clinical policy creation, electronic clinical decision support, and continuous auditing and feedback.
Annualized daily order volumes decreased from approximately 25,000 to 10,000 during a 33-month postintervention review. This represented a significant change from preintervention order volumes (95% confidence interval, 0.61-0.64; P < 10-16). Total inpatient test volumes were not affected.
Durable changes to inpatient order practices can be achieved through a collaborative approach to utilization management that includes shared responsibility for establishing clinical guidelines and electronic decision support. Our experience suggests auditing and continued feedback are additional crucial components to changing ordering behavior. Curtailing daily orders alone may not be a sufficient strategy to reduce in-laboratory costs.
我们试图通过多方面改变医嘱模式的方法来解决对反复进行的住院实验室检查医嘱操作（每日实验室检查）的担忧。
我们开展了部门间合作，通过制定临床政策、电子临床决策支持以及持续审计和反馈来促进谨慎的检查医嘱开具。
在干预后的33个月审查期间，年化每日医嘱量从约25,000降至10,000。这与干预前的医嘱量相比有显著变化（95%置信区间，0.61 - 0.64；P < 10 - 16）。住院患者检查总量未受影响。
通过一种利用管理的协作方法可以实现住院医嘱操作的持久改变，该方法包括共同负责制定临床指南和电子决策支持。我们的经验表明，审计和持续反馈是改变医嘱行为的另外两个关键组成部分。仅减少每日医嘱可能不是降低实验室成本的充分策略。
