“Send & hold” clinical decision support rules improvement to reduce unnecessary testing of vitamins A, E, K, B1, B2, B3, B6 and C
-
Enrique Rodriguez-Borja
,
Africa Corchon-Peyrallo
Abstract
Background:
We assessed the impact of several “send & hold” clinical decision support rules (CDSRs) within the electronical request system for vitamins A, E, K, B1, B2, B3, B6 and C for all outpatients at a large health department.
Methods:
When ordered through electronical request, providers (except for all our primary care physicians who worked as a non-intervention control group) were always asked to answer several compulsory questions regarding main indication, symptomatology, suspected diagnosis, vitamin active treatments, etc., for each vitamin test using a drop-down list format. After samples arrival, tests were later put on hold internally by our laboratory information system (LIS) until review for their appropriateness was made by two staff pathologists according to the provided answers and LIS records (i.e. “send & hold”). The number of tests for each analyte was compared between the 10-month period before and after CDSRs implementation in both groups.
Results:
After implementation, vitamins test volumes decreased by 40% for vitamin A, 29% for vitamin E, 42% for vitamin K, 37% for vitamin B1, 85% for vitamin B2, 68% for vitamin B3, 65% for vitamin B6 and 59% for vitamin C (all p values 0.03 or lower except for vitamin B3), whereas in control group, the majority increased or remained stable. In patients with rejected vitamins, no new requests and/or adverse clinical outcome comments due to this fact were identified.
Conclusions:
“Send & hold” CDSRs are a promising informatics tool that can support in utilization management and enhance the pathologist’s leadership role as tests specialist.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
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©2018 Walter de Gruyter GmbH, Berlin/Boston
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Articles in the same Issue
- Frontmatter
- Editorial
- Free light chains in the cerebrospinal fluid. Do we still need oligoclonal IgG?
- Reviews
- Obese phenotype and natriuretic peptides in patients with heart failure with preserved ejection fraction
- Prognostic value of HE4 in patients with ovarian cancer
- Opinion Paper
- Laboratory hemostasis: from biology to the bench
- Genetics and Molecular Diagnostics
- Multicenter validation study for the certification of a CFTR gene scanning method using next generation sequencing technology
- General Clinical Chemistry and Laboratory Medicine
- IL8 and IL16 levels indicate serum and plasma quality
- “Send & hold” clinical decision support rules improvement to reduce unnecessary testing of vitamins A, E, K, B1, B2, B3, B6 and C
- CSF free light chain identification of demyelinating disease: comparison with oligoclonal banding and other CSF indexes
- Search for new biomarkers of pediatric multiple sclerosis: application of immunoglobulin free light chain analysis
- The importance of detecting anti-DFS70 in routine clinical practice: comparison of different care settings
- Higher D-lactate levels are associated with higher prevalence of small dense low-density lipoprotein in obese adolescents
- LC-MSMS assays of urinary cortisol, a comparison between four in-house assays
- Optimized angiotensin-converting enzyme activity assay for the accurate diagnosis of sarcoidosis
- Quantitative urine test strip reading for leukocyte esterase and hemoglobin peroxidase
- Performance evaluation of cobas HBV real-time PCR assay on Roche cobas 4800 System in comparison with COBAS AmpliPrep/COBAS TaqMan HBV Test
- Systematic comparison of routine laboratory measurements with in-hospital mortality: ICU-Labome, a large cohort study of critically ill patients
- Reference Values and Biological Variations
- Establishing reference intervals for sex hormones and SHBG in apparently healthy Chinese adult men based on a multicenter study
- Plasma midregional proadrenomedullin (MR-proADM) concentrations and their biological determinants in a reference population
- Cancer Diagnostics
- Analytical validation of the Hevylite assays for M-protein quantification
- Cardiovascular Diseases
- Assessing matrix, interferences and comparability between the Abbott Diagnostics and the Beckman Coulter high-sensitivity cardiac troponin I assays
- Infectious Diseases
- Evaluation of a novel prognostic score based on thrombosis and inflammation in patients with sepsis: a retrospective cohort study
- Letters to the Editor
- Independent evaluation using fresh patient samples under real clinical conditions is vital for confirming the suitability and marketability of any new HbA1c assay. An example
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- Site-specific DNA methylation detection based on enzyme-linked immunosorbent assay using recombinant methyl-CpG binding protein
- 3q29 microduplication in a small family with complex metabolic phenotype from Southern Italy
- A D1424N mutation in the MYH9 gene results in macrothrombocytopenia and granulocytic inclusion bodies in a Chinese inherited macrothrombocytopenia pedigree
- Evaluation of analytical performance of a chemiluminescence enzyme immunoassay (CLEIA) for cTnI using the automated AIA-CL2400 platform
- Cellular markers of eryptosis are altered in type 2 diabetes
- Platelet serotonin is not elevated in patients with benign head and neck paragangliomas
