The sustainable impact of an educational approach to improve the appropriateness of laboratory test orders in the ICU.
<h4>Introduction</h4>Few studies described strategies to improve the use of diagnostic tests in intensive care units (ICU). No study assessed whether their impact was sustained or not. In this study, we assessed whether a multi-faceted intervention for more appropriate use of laboratory...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2019-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0214802 |
| _version_ | 1797661422078918656 |
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| author | Benjamin Clouzeau Marie Caujolle Aurelie San-Miguel Jerome Pillot Nathalie Gazeau Christophe Tacaille Vincent Dousset Fabienne Bazin Frederic Vargas Gilles Hilbert Mathieu Molimard Didier Gruson Alexandre Boyer |
| author_facet | Benjamin Clouzeau Marie Caujolle Aurelie San-Miguel Jerome Pillot Nathalie Gazeau Christophe Tacaille Vincent Dousset Fabienne Bazin Frederic Vargas Gilles Hilbert Mathieu Molimard Didier Gruson Alexandre Boyer |
| author_sort | Benjamin Clouzeau |
| collection | DOAJ |
| description | <h4>Introduction</h4>Few studies described strategies to improve the use of diagnostic tests in intensive care units (ICU). No study assessed whether their impact was sustained or not. In this study, we assessed whether a multi-faceted intervention for more appropriate use of laboratory testing can decrease the number of tests, is sustainable, is not associated with additional morbidity and represents a potential cost saving.<h4>Material and methods</h4>An open-label prospective cohort study in two separated units of the same medical intensive care unit (ICU) including respectively 3315 and 2392 consecutive patients. After the observation period (2010), a reduction in ICU A of unnecessary diagnostics tests as part of a program including senior supervisory of juniors' orders, encouragements for orders containment at each everyday round discussions (period 2; 2011). Period 3 (2012) consisted in the prolongation of the protocol as a routine care without supervision; Period 4 (2013) was a new period of observation without intervention. No modification was implemented in ICU B in periods 2-4.<h4>Results</h4>After the intervention, a decrease in the overall number of tests per ICU-patient-days (37.3±5.5 (baseline) to 15.2±3.2 (- 59%); p<0.0001) was observed. The total cost of the tests decreased from 239±41 to 104±28 euros per ICU-patient days; p<0.0001. The effect on laboratory test orders was sustainable in period 3 (-49%) and 4 (-30%). No significant secondary effect of the intervention was observed in period 2. In ICU B, there was no significant change in the overall laboratory test orders in between the periods.<h4>Conclusions</h4>Laboratory test containment is effective, likely safe and sustainable provided that an educational program is repeatedly promoted, that it makes sense for the whole team, that senior and junior physicians are both committed in the program, and that encouragements for laboratory orders containment at each everyday round discussions. |
| first_indexed | 2024-03-11T18:45:16Z |
| format | Article |
| id | doaj.art-f9d64a68b1e841919d68026f57456b7d |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-03-11T18:45:16Z |
| publishDate | 2019-01-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS ONE |
| spelling | doaj.art-f9d64a68b1e841919d68026f57456b7d2023-10-12T05:31:48ZengPublic Library of Science (PLoS)PLoS ONE1932-62032019-01-01145e021480210.1371/journal.pone.0214802The sustainable impact of an educational approach to improve the appropriateness of laboratory test orders in the ICU.Benjamin ClouzeauMarie CaujolleAurelie San-MiguelJerome PillotNathalie GazeauChristophe TacailleVincent DoussetFabienne BazinFrederic VargasGilles HilbertMathieu MolimardDidier GrusonAlexandre Boyer<h4>Introduction</h4>Few studies described strategies to improve the use of diagnostic tests in intensive care units (ICU). No study assessed whether their impact was sustained or not. In this study, we assessed whether a multi-faceted intervention for more appropriate use of laboratory testing can decrease the number of tests, is sustainable, is not associated with additional morbidity and represents a potential cost saving.<h4>Material and methods</h4>An open-label prospective cohort study in two separated units of the same medical intensive care unit (ICU) including respectively 3315 and 2392 consecutive patients. After the observation period (2010), a reduction in ICU A of unnecessary diagnostics tests as part of a program including senior supervisory of juniors' orders, encouragements for orders containment at each everyday round discussions (period 2; 2011). Period 3 (2012) consisted in the prolongation of the protocol as a routine care without supervision; Period 4 (2013) was a new period of observation without intervention. No modification was implemented in ICU B in periods 2-4.<h4>Results</h4>After the intervention, a decrease in the overall number of tests per ICU-patient-days (37.3±5.5 (baseline) to 15.2±3.2 (- 59%); p<0.0001) was observed. The total cost of the tests decreased from 239±41 to 104±28 euros per ICU-patient days; p<0.0001. The effect on laboratory test orders was sustainable in period 3 (-49%) and 4 (-30%). No significant secondary effect of the intervention was observed in period 2. In ICU B, there was no significant change in the overall laboratory test orders in between the periods.<h4>Conclusions</h4>Laboratory test containment is effective, likely safe and sustainable provided that an educational program is repeatedly promoted, that it makes sense for the whole team, that senior and junior physicians are both committed in the program, and that encouragements for laboratory orders containment at each everyday round discussions.https://doi.org/10.1371/journal.pone.0214802 |
| spellingShingle | Benjamin Clouzeau Marie Caujolle Aurelie San-Miguel Jerome Pillot Nathalie Gazeau Christophe Tacaille Vincent Dousset Fabienne Bazin Frederic Vargas Gilles Hilbert Mathieu Molimard Didier Gruson Alexandre Boyer The sustainable impact of an educational approach to improve the appropriateness of laboratory test orders in the ICU. PLoS ONE |
| title | The sustainable impact of an educational approach to improve the appropriateness of laboratory test orders in the ICU. |
| title_full | The sustainable impact of an educational approach to improve the appropriateness of laboratory test orders in the ICU. |
| title_fullStr | The sustainable impact of an educational approach to improve the appropriateness of laboratory test orders in the ICU. |
| title_full_unstemmed | The sustainable impact of an educational approach to improve the appropriateness of laboratory test orders in the ICU. |
| title_short | The sustainable impact of an educational approach to improve the appropriateness of laboratory test orders in the ICU. |
| title_sort | sustainable impact of an educational approach to improve the appropriateness of laboratory test orders in the icu |
| url | https://doi.org/10.1371/journal.pone.0214802 |
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