ELIMINATING NEEDLESS TESTING IN INTENSIVE-CARE - AN INFORMATION-BASED TEAM MANAGEMENT APPROACH

Objective: To determine if the application of an information-based management system in adult intensive care units (ICU) can produce sustained decreases in the use of laboratory resources and costs. Design: Interventional study with prospective data collection on consecutive patients admitted during three time periods. Setting. A 10-bed adult surgical ICU and an eight-bed adult medical ICU in a tertiary care hospital. Patients. All patients admitted to an ICU during a 7-month baseline period (n = 647), a 1 -yr intervention period (n = 1236), and a 2-yr follow-up period (n = 2349). Interventions: Using a management database to track the use of 123 laboratory investigations during the baseline period, nine frequently ordered investigations (determination of blood gases, glucose, potassium, electrocardiogram, chest radiograph, sodium, chloride, complete blood count with differential, and serum osmolality) were targeted for reduction. Specific policies were developed by a multidisciplinary committee within the ICU to reduce the utilization of these laboratory, radiology, and cardiology tests. The policies were applied to all patients admitted during the 1 -yr intervention period and during the 2-yr follow-up period. Measurements and Main Results: A 25% reduction was observed in the frequency of all 123 monitored tests during the intervention period. The most dramatic reductions occurred in the nine targeted tests (range 19% to 46%) (p <.001). There were significant reductions in only 13 of the untargeted 114 investigations during this period. Potential annual cost savings were >$150,000 Canadian. No increases in ICU mortality rate, length of stay, or cost of medication were observed, and the reductions in the frequency of targeted tests were maintained during the 2-yr follow-up period. Conclusions: Application of an information-based multidisciplinary management system in the ICU can produce marked and sustained reductions in unnecessary testing in a cost-effective manner. Although rationing of intensive care services may be necessary, reducing needless testing can be a safe and effective cost-containment strategy in the ICU.