PRACTICE GUIDELINE FOR ARTERIAL BLOOD-GAS MEASUREMENT IN THE INTENSIVE-CARE UNIT DECREASES NUMBERS AND INCREASES APPROPRIATENESS OF TESTS

Objective: To test the hypothesis that implementation of a practice gu ideline for blood gas measurement would decrease numbers acid increase appropriateness of tests (according to criteria in the guideline) for up to 1 yr after introduction of the guideline. Design: Numbers of te sts and appropriateness of each test were measured retrospectively dur ing each of five periods: two baseline periods 2 yrs and 1 yr before i ntroduction of the guideline and three follow-up periods 2 to 3 months , 6 to 7 months, and 12 to 13 months after introduction of the guideli ne. Setting: A ten-bed multidisciplinary intensive care unit (ICU) wit hin a 500-bed tertiary teaching hospital. Patients: A random sample of 30 patients admitted to the ICU during each of the periods specified above. Interventions: The nominal group process was used to develop a new guideline and a multipronged educational approach was used to faci litate implementation of the guideline. Measurements and Main Results: At 2 to 3 months, test numbers decreased from 4.9 +/- 1.6 to 3.1 +/- 1.8 (SD) tests/patient/day and to 2.4 +/- 1.2 tests/patient/day at 12 to 13 months. Appropriateness increased from a mean of 44% at baseline to 78% at 2 to 3 months and 79% at 12 to 13 months, There were no dif ferences in Acute Physiology and Chronic Health Evaluation scores or I CU mortality among the patient groups and no differences in number of ventilator days or time to wean from ventilation. Cost-minimization an alysis showed that the incremental cost-saving 1 yr after introduction of the guideline was $19.18 per patient per day. Conclusions: Impleme ntation of this guideline for arterial blood gas measurement increases efficiency of test utilization without prolonging mechanical ventilat ion or affecting outcome.