Friday, August 22, 2014

It Is Interesting How Even Small Changes In Clinical Order Paths Can Make A Big Difference.

This appeared a little while ago:

Hopkins Tweaks CPOE, Saves $1.25 Million

Greg Goth
JUL 8, 2014 9:25am ET
Researchers at Johns Hopkins Bayview Medical Center, Baltimore, used two relatively simple tactics to significantly reduce the number of unnecessary blood tests to assess symptoms of heart attack and chest pain, and to achieve a large decrease in patient charges.
The team provided information about testing guidelines and made changes to the computerized physician order entry system at the medical center, part of the Johns Hopkins Health System. The guidelines call for more limited use of blood tests for cardiac biomarkers. A year after implementation, the guidelines saved the medical center an estimated $1.25 million in laboratory charges.
Part of the focus was on tests to assess levels of troponin, a protein whose components increase in the blood when heart muscle is damaged. Frequently, troponin tests are repeated four or more times in a 24-hour period, which studies have suggested is excessive, and they are often done along with tests for other biomarkers that are redundant. The new guidelines suggest ordering troponin alone, without creatine kinase or creatine kinase-MB, for patients suspected to have acute coronary syndrome. It specifies that troponin should be assessed no more than three times over 18 to 24 hours.
More here:
The article says it all. Small changes can make a big difference. It incidentally  points out that care with the design of clinical order sets can be a substantial difference to both the quality of care and the cost of care.
There is also detailed press release and link to publication found here:

Efforts to Cut Unnecessary Blood Testing Bring Major Decreases in Health Care Spending

Researchers at Johns Hopkins Bayview Medical Center used two relatively simple tactics to significantly reduce the number of unnecessary blood tests to assess symptoms of heart attack and chest pain and to achieve a large decrease in patient charges.
The team provided information and education to physicians about proven testing guidelines and made changes to the computerized provider order entry system at the medical center, part of the Johns Hopkins Health System. The guidelines call for more limited use of blood tests for so-called cardiac biomarkers. A year after implementation, the guidelines saved the medical center an estimated $1.25 million in laboratory charges.
In this case, part of the focus was on tests to assess levels of troponin, a protein whose components increase in the blood when heart muscle is damaged. Frequently, troponin tests are repeated four or more times in a 24-hour period, which studies have suggested is excessive, and they are often done along with tests for other biomarkers that are redundant.
In a report published June 28 in the Journal of General Internal Medicine, the research team describes how these interventions reduced overuse of troponin and other biomarker testing without compromising patient care. If adopted widely, the team says, cost savings could be substantial.
“This study has broader implications for the health care system, as most hospitals continue to redundantly test people for chest pain and other symptoms,” says report author Jeffrey C. Trost, M.D., an assistant professor of medicine, director of the cardiac catheterization laboratory and co-director of interventional cardiology at Johns Hopkins Bayview Medical Center. “Implementing our interventions could save patients and society a significant amount of money, potentially several billion dollars.”
Full release
 Here is the link to the paper:
Enjoy!
David.

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