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Intensive Care Med (2009) 35:10471053DOI 10.1007/s00134-009-1438-z ORIGINAL
Gwnal Prat Montaine Lefvre Emmanuel Nowak Jean-Marie Tonnelier Anne RenaultErwan LHer Jean-Michel Boles
Impact of clinical guidelines to improve appropriateness of laboratory testsand chest radiographs
Abstract Objective: To assess the impact of clinical guidelines to improve appropriate use of routine laboratory tests and bedside chest radiographs in a medical intensive care. Design: A two-year (Period-1: 2005, Period-2: 2006), retrospective, comparative study, before and after policy implementation. Patients:All consecutive patients admitted during the study periods. Setting: A university hospital 15-bed medical ICU. Intervention: Multifaceted intervention combining a daily routine prescription help-guide developed by a multidisciplinary group and displayed at patients bedside, educational sessions and feedbacks by information on volumes of prescription. Individual adaptation to patients clinical status was allowed by protocol. Assessment: The overall number and cost of laboratory tests and chest radio-graphs during Period-2 (with the help guide; from 01 to 12-2006) were compared to Period-1 (from 01 to
12-2005). Results: Patients general characteristics were similar during the two periods. A relative reduction of routine laboratory tests performance was observed per patient-ICU-day, ranging from 38 to 71.5% depending on the type of tests (P \ 0.001 in all cases). For chest radiographs, a 41%
relative reduction was observed between the two periods (P \ 0.001).
Daily ICU laboratory tests and chest radiographs cost per patient decreased from 114 to 56. An overall 300,000 ICU cost reduction was directly related to the protocol implementation. Conclusion: The implementation of a laboratory tests and chest radio-graphs prescription protocol within our ICU induced an important cost saving.
Keywords Chest radiograph
Laboratory testing Practice
guideline Healthcare cost control
Cost savings Quality improvement
Received: 24 June 2008 Accepted: 24 January 2009 Published online: 17 February 2009 Springer-Verlag 2009
G. Prat ()) M. Lefvre
J.-M. Tonnelier A. Renault
E. LHer J.-M. Boles
Ranimation Mdicale,Ple Vasculaire-Urgences, Centre Hospitalier Universitaire de la Cavale Blanche, Bd Tanguy Prigent,29609 Brest Cedex, Francee-mail: [email protected] Tel.: ?33-2-98347181Fax: ?33-2-98347965
E. NowakCentre dinvestigation clinique CIC 05-02 (INSERM), Centre Hospitalier Universitaire de la Cavale Blanche, 29609 Brest Cedex, France
Introduction
No guideline denes the adequate frequency of routine laboratory tests (RLT) and chest radiographs (CXRs) for ICU patients. Expenditure due to these prescriptions increases continuously and represents up to 25% of the care cost...