(P219) A LOW-COST INITIATIVE TO REDUCE UNNECESSARY BLOODWORK ON CARDIOLOGY WARDS

Background: Patients admitted to the Cardiology wards receive frequent routine blood tests, many of which do not affect clinical decision making, rendering them unnecessary. Unnecessary bloodwork has many adverse effects, including iatrogenic anemia, patient discomfort, increased nursing workload, and increased healthcare costs.

METHODS AND RESULTS: This was a 4-week initiative using the Plan-Do-Study-Act model, which took place in an 18-bed Cardiology Intermediate Care Unit at a tertiary care hospital. Prior to the initiative, bloodwork usage was studied to deduce practice patterns. During the first two weeks, daily bloodwork orders were written into each patient’s chart. During the second two weeks, to increase efficiency and to draw nurses’ attention, stickers with daily bloodwork orders were placed into patients’ charts, in place of handwritten orders. Observations during the implementation of each phase were recorded. The main outcome of interest was the average number of daily bloodwork per patient. The main balancing measure was length of stay.

82 patients were included, with an average age of 65.0 +/- 16.7 years. 18 patients (21.7%) were female. The top admission diagnoses were acute coronary syndrome (n=42, 51.2%), heart failure (n=16, 19.5%), ventricular arrhythmia (n=7, 8.5%), bradyarrhythmia (n=7, 8.5%), and post-cardiac arrest (n=5, 6.1%). During the first two weeks, an average of 10.8 blood tests were processed per patient per day. The most frequently ordered bloodwork included electrolytes (sodium, potassium, magnesium, calcium, and phosphate), complete blood count, creatinine, urea, partial thromboplastin time (PTT), and international normalized ratio (INR). The average length of stay was 5.6 +/- 4.5 days. During this initial phase, additional blood tests were often sent, even if specific orders were written in the chart. This was attributed to nurses on night shifts not being aware of the written bloodwork orders. During the second two weeks, using stickers with bloodwork orders, an average of 6.7 blood tests were processed per patient per day—a 38% decrease. This translated to a cost saving of an estimated $7.11 per patient per day. The average length of stay was similar at 4.8 +/- 3.0 days.

Conclusion: The utilization of stickers with daily bloodwork orders successfully decreased the number of blood tests processed by 38%, with no significant effect on patients’ length of stay. Future efforts will focus on incorporating daily bloodwork stickers as a part of physicians’ workflow and educating nurses about unnecessary bloodwork. Similar initiatives can also be adapted at institutions that use electronic medical records.