Inappropriate NT-proBNP short-term repeat testing: effectiveness of an electronic alert

Abstract

Abstract Background NT-proBNP is a costly laboratory marker commonly employed as a diagnostic and prognostic biomarker in heart failure (HF). While it may be helpful during admission and discharge for patients with acute decompensated HF (ADHF), it may not be appropriate to measure it repeatedly over a short period of time due to the associated unnecessary expenses. Objective To determine the effectiveness of an electronic alert on reducing the prevalence of inappropriate use of NT-proBNP and estimate the potential cost savings. Methods We introduced an electronic alert on the 25th Nov 2022 that required clinicians to provide a clinical justification for ordering NT-proBNP within 5 days of a previous test result. The alert could easily be dismissed with a single keystroke. We assessed the percentage of potentially unnecessary testing (i.e. repeat testing within less than 5 days) during the intervention period (duration of 1 month, from 25th Nov to 15th Dec 2022) and compared it to two control periods: the 2 months previous to the intervention, from 1st Oct to 24th Nov 2022 (control period A), and one year before the intervention, from 25th Nov-15th Dec 2021 (control period B). The cost of each test was estimated at €29.60. Results During the intervention period, the total number (n) of NTproBNP tests ordered and the percentage (%) of repeat testing in less than 5 days was n=1022 and 20%, respectively. During the control period A, the numbers were n=2543 and 22%, respectively. During the control period B, these values were n=840 and 20%, respectively. The percentage of potential inappropriate testing was not significantly different when comparing the intervention period to the control period A (p=0.74) and control period B (p=0.48). The total number of NT-proBNP tests per year is around 11 000. A strategy that would reduce potential 20% inappropriate tests would save €65 120 per year. Conclusion Around 20% of NT-proBNP tests are ordered within 5 days or less of a previous test. An electronic alert prompting doctors to type a clinical justification for the NT-proBNP whenever a result was available in the previous 5 days is not effective. An effective intervention to reduce inappropriate testing could save over €65 000 per year in a moderate dimension hospital. More effective strategies are necessary.