Abstract
BackgroundDaily routine laboratory testing is unnecessary in most admitted patients. The opportunity to reduce daily laboratory testing in orthopaedic trauma patients has not been previously investigated.MethodsA prospective observational study was performed based on a new laboratory testing reduction protocol for 12 months at two tertiary care trauma centers. Admitted patients with surgically treated isolated upper or lower extremity fractures were included (n = 246). The testing protocol consisted of a complete blood count (CBC) and basic metabolic panel (BMP) on postoperative day 2. Thereafter, tests were obtained at individual providers’ discretion. Patients were followed for 30 days postoperatively. The primary outcome was number of laboratory tests reduced. Secondary outcomes included provider protocol compliance, and adverse patient outcomes. Chi-squared tests were used to compare differences in categorical variables among the cohorts. Analysis of variance tests were used for continuous variables. The relative reductions in testing utilization were calculated using our division’s standard-of-care before program implementation (1 CBC and 1 BMP per patient per inpatient day). Significance was defined as P < 0.05.ResultsOf the 246 patients, there were 45 protocol fall outs due to provider deviation (n = 24) or medically justified necessity for additional testing (n = 21). Across all groups, a total of 778 CBC or BMP tests were avoided, amounting to a 69% reduction in testing compared to the pre-implementation baseline. Ninety-five percent of protocol group patients were safely discharged either without laboratory testing or with one set of tests obtained on postoperative day 2. There were no 30-day readmissions or reported complications associated with the new laboratory testing protocol.ConclusionsIn patients with surgically treated fractures about the elbow and knee, obtaining a single set of laboratory tests on postoperative day 2 is safe and efficacious in terms of reducing inappropriate resource utilization.Trial registrationretrospectively registered.
Highlights
In 2017, United States health care expenditure accounted for nearly 18% of gross domestic product [1]
Laboratory testing is associated with patient harm, including technical errors, pain, and phlebotomy-associated anemia [12,13,14]
Given the unclear benefit of daily postoperative testing in the orthopaedic trauma surgery population, we investigated the outcomes of reduced laboratory testing frequency in our patient population
Summary
In 2017, United States health care expenditure accounted for nearly 18% of gross domestic product [1]. Resources are progressively strained with growing health care demands Initiatives to reduce these costs are designed to decrease inappropriate resource utilization, including allogeneic red blood cell transfusions, urinary catheter use, continuous telemetry monitoring, and daily laboratory testing [2,3,4,5,6,7]. Laboratory testing has been recognized is one of the top 5 most overused diagnostic measures for hospitalized patients [2, 8, 9]. Laboratory testing is associated with patient harm, including technical errors, pain, and phlebotomy-associated anemia [12,13,14]. The opportunity to reduce daily laboratory testing in orthopaedic trauma patients has not been previously investigated
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