Amanda Haney, ACNP, MS, MS, BSN
Lead Advanced Practice Provider Surgical Intensive Care Unit
The James Comprehensive Cancer Center
Columbus, Ohio
Disclosure information not submitted.
Claire Murphy, BCPS, PharmD, FCCM
Lead Critical Care Specialty Practice Pharmacist
n/a
Columbus, Ohio
Disclosure information not submitted.
Anthony Gerlach, PharmD, FCCM
Clinical Pharmacist
Ohio State University Wexner Medical Center
Columbus, Ohio
Disclosure information not submitted.
Markisha Wilder, ACNP, AGACNP-BC
James Cancer Hospital and Solove Research Center
Columbus, Ohio
Disclosure information not submitted.
Title: Multidisciplinary Quality Initiative Reduces Laboratory Utilization in the SICU
Introduction/Hypothesis: Improving Quality of Care and Decreasing Cost Is a Top Priority for US Healthcare. Patients in the Surgical Intensive Care Unit (SICU) Are Inherently at Risk for Blood Loss Due to Traumatic Injuries or Surgical Consequences, and Frequent and Routine Laboratory (Lab) Monitoring Can Have Additive Negative Effects. The Purpose of This Study Was to Compare Lab Utilization Before and After Implementation of an Evidence-Based Quality Initiative to Reduce the Number of Labs Ordered per Patient Day (Labs/Pt/D) in the SICU.
Methods: A Single-Center, Pre/Post Study of Patients Admitted to Two SICUs (One Staffed by Apps/Intensivist and One Staffed by a Combination of APPs/Residents/Intensivist) Between August 2018 and February 2020. In August 2019, a Multidisciplinary Quality Initiative Was Implemented to Reduce Lab Utilization. The Plan, Including an SBAR Tool and Education, Was Shared with Interprofessional SICU Staff and Faculty. Interventions Included Review of Lab Orders on Daily Rounds and Addition to the Rounding Checklist, Updated Note Templates, and Revised Order-Sets. Lab Utilization Data Were Collected as Labs/Pt/D in an Electronic Dashboard, Which Were Reviewed Weekly and Shared with Teams Monthly. Baseline Data from August 2018 to February 2019 Prior to Implementation (Pre) Were Compared to Post Implementation Data from August 2019 to February 2020 (Post). Statistical Analysis Was Performed by X2.
Results: A Total of 827 Patients Were Included in the Pre Group and 864 Patients in the Post Group. The Total Labs/Pt/D for Both SICUs Decreased from 13.91 to 13.43 (P=0.087). In the APP/Intensivist Staffed SICU the Labs/Pt/D Decreased from 14.45 (Pre) to 13.00 (Post; P=0.011). In the APP/Resident/Intensivist Staffed SICU There Was No Difference 13.74 (Pre) and 13.56 (Post; P=0.59).
Conclusion: A Multidisciplinary Laboratory Reduction Quality Initiative May Reduce the Number of Labs/Pt/D, with Significant Decrease in the APP Staffed Unit. Opportunity for Increased Efficiency Were Identified in the SICU Staffed by APPs/Residents/Intensivists.