Department of Surgery, Wollongong Public Hospital, 252 Loftus Street, Wollongong, NSW 2500, Australia.
Department of Surgery, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia.
Int J Qual Health Care. 2021 May 28;33(2). doi: 10.1093/intqhc/mzab083.
Laboratory testing forms an important part of diagnostic investigation in modern medicine; however, the overuse of 'routine blood tests' can result in significant potential harm and financial cost to the patient and the healthcare system. In 2018, a new protocol targeting the ordering of investigations was implemented within the General Surgical Teams of Wollongong Hospital in New South Wales, an Australian tertiary referral hospital, to reduce the number of 'routine blood tests' as a quality improvement initiative.
To identify whether there was a reduction in the number of 'routine blood tests' and associated costs following implementation of the new protocol.
The protocol involved regular review of the laboratory investigations being ordered for the following day with a senior team member. The medical records of all patients admitted under the general surgery service at Wollongong Hospital were retrospectively reviewed over two 10-week periods in 2017 and 2018 (control and study, respectively). The casemix was categorized into Minor, Intermediate, Major or Unscored, depending on case complexity coding.
A total of 838 patients were identified during the control period (2017) and 805 patients were identified during the study period (2018). Ten thousand and thirty tests were included in the control period, compared to 8610 over the study period, resulting in a 16% (or greater) reduction in 'routine blood tests' per patient, per day of admission and a 6% reduction in costs in the study group (P < 0.001).
Targeted ordering of investigations with personalized education and feedback to junior staff during review of clinical status of each patient as a part of normal workflow can reduce inappropriate ordering of 'routine blood tests' and associated costs to the patient and the healthcare system.
实验室检测是现代医学诊断调查的重要组成部分；然而，过度使用“常规血液检测”可能会给患者和医疗系统带来重大的潜在危害和经济成本。2018 年，澳大利亚三级转诊医院新南威尔士州卧龙岗医院的普通外科团队实施了一项新的调查指令方案，作为一项质量改进措施，以减少“常规血液检测”的数量。
确定实施新方案后“常规血液检测”的数量和相关成本是否减少。
该方案涉及由一名高级团队成员定期审查次日要进行的实验室检查。对 2017 年和 2018 年（对照组和研究组）期间在卧龙岗医院普通外科服务下住院的所有患者的医疗记录进行回顾性分析。根据病例复杂程度编码，将病例组合分为小、中、大或无评分。
对照组（2017 年）共确定了 838 例患者，研究组（2018 年）共确定了 805 例患者。对照组纳入 10030 项检测，研究组纳入 8610 项检测，导致每位患者每天的“常规血液检测”减少了 16%（或更多），研究组的成本减少了 6%（P<0.001）。
作为正常工作流程的一部分，针对每位患者的临床状况进行调查指令的有针对性的安排，并对初级工作人员进行个性化教育和反馈，可以减少“常规血液检测”的不当订购和对患者及医疗系统的相关成本。
