Duplicate Laboratory Test Reduction Using a Clinical Decision Support Tool

This is a review Gary W. Procop MD, Lisa M. Yerian MD, Robert Wyllie, MD, A. Marc Harrison, MD, and Kandice Kottke-Marchant, MD, PhD (2014) article, Duplicate Laboratory Test Reduction Using a Clinical Decision Support Tool

Summary

Duplicate lab test results in decreased patient satisfaction, pain associated with the additional phlebotomies; the contribution toward iatrogenic anemia (aka nosocomial anemia or investigational anemia), which in turn affects wound healing and infection; and increased health care costs accrued through specimen collection, transport, testing, resulting, and the clinical response to the result.

Method

In this study, the authors uses a Computerized Physician Order Entry (CPOE) with Clinical Decision Support (CDS) to block duplicate test orders and assessed the total cost savings in two years. The location of this study was conducted at Cleveland Clinic who uses Epic as their EHR and Sunquest as their Laboratory Information Management System (LIMS).

Results

As a result, 11,790 unnecessary duplications were blocked using the CDS, saving $183,586 in 2 years.

Challenges

• Duplicate test within multiple order sets
• Duplicate test which are necessary due to collection and transportation issues

Conclusion

Eliminating duplicate laboratory test can not only increase patient satisfaction but also save the hospital money which can then be used towards improving patient care.

Comments

I agree with the authors in their study and a lot of what they said. A lot of times, the 2nd physician who is placing the order is completely unaware that there is an existing order. And if they do get a notification or an alert about the duplication, the physician will override the order in assumption that the lab will take care of it. But in reality, it is not the lab technicians' responsibility to find and remove duplicate orders. Some things that alerts should include is 1) the most recent lab results for the duplicate tests being ordered and 2) the ability to remove an order within the alert if there was a duplication.