1. The sustainable impact of an educational approach to improve the appropriateness of laboratory test orders in the ICU
- Author
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Fabienne Bazin, Aurelie San-Miguel, Vincent Dousset, Alexandre Boyer, Benjamin Clouzeau, Gilles Hilbert, Marie Caujolle, Christophe Tacaille, Frédéric Vargas, Jerome Pillot, Didier Gruson, Mathieu Molimard, Nathalie Gazeau, Department of Intensive Care Medicine [Bordeaux], CHU de Bordeaux Pellegrin [Bordeaux], Economic and Financial Department [Bordeaux], Departments of Laboratories [Bordeaux], Department of Radiology [Bordeaux], Pharmacoepidemiologie et évaluation de l'impact des produits de santé sur les populations, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Bordeaux Segalen - Bordeaux 2-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU), Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Bodescot, Myriam
- Subjects
Male ,Medical Doctors ,Physiology ,Health Care Providers ,Peptide Hormones ,Biochemistry ,Brain Natriuretic Peptide ,0302 clinical medicine ,Medicine and Health Sciences ,Medicine ,030212 general & internal medicine ,Prospective Studies ,Medical Personnel ,Prospective cohort study ,Multidisciplinary ,Mortality rate ,Diagnostic test ,Hematology ,Hospitals ,Body Fluids ,Laboratory test ,Intensive Care Units ,Professions ,Blood ,Research Design ,Female ,Anatomy ,Research Article ,medicine.medical_specialty ,Critical Care ,Death Rates ,Science ,MEDLINE ,Laboratory Tests ,Unnecessary Procedures ,Research and Analysis Methods ,03 medical and health sciences ,Population Metrics ,Diagnostic Medicine ,Natriuretic Peptide ,Intensive care ,Physicians ,Medical Staff, Hospital ,Humans ,Protocol (science) ,Population Biology ,business.industry ,Diagnostic Tests, Routine ,Biology and Life Sciences ,[SDV.ETH] Life Sciences [q-bio]/Ethics ,Hormones ,[SDV.ETH]Life Sciences [q-bio]/Ethics ,Health Care ,[SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie ,Health Care Facilities ,Emergency medicine ,People and Places ,Population Groupings ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,business ,Educational program ,030217 neurology & neurosurgery - Abstract
IntroductionFew studies described strategies to improve the use of diagnostic tests in intensive care units (ICU). No study assessed whether their impact was sustained or not. In this study, we assessed whether a multi-faceted intervention for more appropriate use of laboratory testing can decrease the number of tests, is sustainable, is not associated with additional morbidity and represents a potential cost saving.Material and methodsAn open-label prospective cohort study in two separated units of the same medical intensive care unit (ICU) including respectively 3315 and 2392 consecutive patients. After the observation period (2010), a reduction in ICU A of unnecessary diagnostics tests as part of a program including senior supervisory of juniors' orders, encouragements for orders containment at each everyday round discussions (period 2; 2011). Period 3 (2012) consisted in the prolongation of the protocol as a routine care without supervision; Period 4 (2013) was a new period of observation without intervention. No modification was implemented in ICU B in periods 2-4.ResultsAfter the intervention, a decrease in the overall number of tests per ICU-patient-days (37.3±5.5 (baseline) to 15.2±3.2 (- 59%); pConclusionsLaboratory test containment is effective, likely safe and sustainable provided that an educational program is repeatedly promoted, that it makes sense for the whole team, that senior and junior physicians are both committed in the program, and that encouragements for laboratory orders containment at each everyday round discussions.
- Published
- 2019