Reducing routine laboratory tests in patients with isolated extremity fractures: A prospective safety and feasibility study in 246 patients

Raj M. Amin, Alexander E. Loeb, Erik Anton Hasenboehler, Adam Levin, Greg Osgood, Robert Steven Sterling, Philip F. Stahel, Babar Shafiq

Research output: Contribution to journalArticle

Abstract

Background: Daily routine laboratory testing is unnecessary in most admitted patients. The opportunity to reduce daily laboratory testing in orthopaedic trauma patients has not been previously investigated. Methods: A prospective observational study was performed based on a new laboratory testing reduction protocol for 12 months at two tertiary care trauma centers. Admitted patients with surgically treated isolated upper or lower extremity fractures were included (n = 246). The testing protocol consisted of a complete blood count (CBC) and basic metabolic panel (BMP) on postoperative day 2. Thereafter, tests were obtained at individual providers' discretion. Patients were followed for 30 days postoperatively. The primary outcome was number of laboratory tests reduced. Secondary outcomes included provider protocol compliance, and adverse patient outcomes. Chi-squared tests were used to compare differences in categorical variables among the cohorts. Analysis of variance tests were used for continuous variables. The relative reductions in testing utilization were calculated using our division's standard-of-care before program implementation (1 CBC and 1 BMP per patient per inpatient day). Significance was defined as P < 0.05. Results: Of the 246 patients, there were 45 protocol fall outs due to provider deviation (n = 24) or medically justified necessity for additional testing (n = 21). Across all groups, a total of 778 CBC or BMP tests were avoided, amounting to a 69% reduction in testing compared to the pre-implementation baseline. Ninety-five percent of protocol group patients were safely discharged either without laboratory testing or with one set of tests obtained on postoperative day 2. There were no 30-day readmissions or reported complications associated with the new laboratory testing protocol. Conclusions: In patients with surgically treated fractures about the elbow and knee, obtaining a single set of laboratory tests on postoperative day 2 is safe and efficacious in terms of reducing inappropriate resource utilization. Trial registration: retrospectively registered.

Original languageEnglish (US)
Article number22
JournalPatient Safety in Surgery
Volume13
Issue number1
DOIs
StatePublished - Jun 14 2019

Keywords

  • High-value care
  • Laboratory testing
  • Orthopaedic trauma surgery
  • Quality improvement

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Anesthesiology and Pain Medicine

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