ELIMINATING NEEDLESS TESTING IN INTENSIVE-CARE - AN INFORMATION-BASEDTEAM MANAGEMENT APPROACH

Objective: To determine if the application of an information-based man agement system in adult intensive care units (ICU) can produce sustain ed decreases in the use of laboratory resources and costs. Design: Int erventional study with prospective data collection on consecutive pati ents admitted during three time periods. Setting. A 10-bed adult surgi cal ICU and an eight-bed adult medical ICU in a tertiary care hospital . Patients. All patients admitted to an ICU during a 7-month baseline period (n = 647), a 1 -yr intervention period (n = 1236), and a 2-yr f ollow-up period (n = 2349). Interventions: Using a management database to track the use of 123 laboratory investigations during the baseline period, nine frequently ordered investigations (determination of bloo d gases, glucose, potassium, electrocardiogram, chest radiograph, sodi um, chloride, complete blood count with differential, and serum osmola lity) were targeted for reduction. Specific policies were developed by a multidisciplinary committee within the ICU to reduce the utilizatio n of these laboratory, radiology, and cardiology tests. The policies w ere applied to all patients admitted during the 1 -yr intervention per iod and during the 2-yr follow-up period. Measurements and Main Result s: A 25% reduction was observed in the frequency of all 123 monitored tests during the intervention period. The most dramatic reductions occ urred in the nine targeted tests (range 19% to 46%) (p <.001). There w ere significant reductions in only 13 of the untargeted 114 investigat ions during this period. Potential annual cost savings were >$150,000 Canadian. No increases in ICU mortality rate, length of stay, or cost of medication were observed, and the reductions in the frequency of ta rgeted tests were maintained during the 2-yr follow-up period. Conclus ions: Application of an information-based multidisciplinary management system in the ICU can produce marked and sustained reductions in unne cessary testing in a cost-effective manner. Although rationing of inte nsive care services may be necessary, reducing needless testing can be a safe and effective cost-containment strategy in the ICU.