Impact of Interventions to Change CBC and Differential Ordering Patterns in the Emergency Department

Am J Clin Pathol. 2019 Jan 7;151(2):194-197. doi: 10.1093/ajcp/aqy128.

Abstract

Objectives: A CBC with leukocyte differential (CBC-DIFF) is a frequently ordered emergency department (ED) test. The DIFF component often does not add to clinical decision making. Our objective was to evaluate the impact of a performance improvement project on CBC ordering.

Methods: ED orders for CBC-DIFF were identified through the laboratory information system. Two interventions were evaluated: an educational intervention regarding CBC-DIFF uses and a reprioritization of ED CBC-DIFF and CBC in the electronic medical record (EMR) orders. Pearson χ2 tests were used to assess for differences in the proportions.

Results: There was no difference in the proportion of CBC tests performed after the education intervention (175/6,192, 2.8% [95% CI, 2.39%-3.21%] vs 219/6,270, 3.5% [95% CI, 3.05%-3.95%]). There was a significant increase in CBC samples ordered following the EMR intervention (604/6,044, 9.1% [95% CI, 8.37%-9.83%]; P < .01).

Conclusions: Reprioritizing EMR laboratory orders can reduce overutilization of CBC-DIFF testing.

MeSH terms

  • Blood Cell Count / statistics & numerical data
  • Clinical Decision-Making*
  • Cohort Studies
  • Electronic Health Records
  • Emergency Service, Hospital
  • Humans
  • Inservice Training
  • Leukocytes / cytology
  • Medical Staff, Hospital / education
  • Practice Patterns, Physicians'*
  • Prospective Studies
  • Unnecessary Procedures / statistics & numerical data