scholarly journals P118: Effects of system design on laboratory utilization in the emergency department: the case for INR & aPTT

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S118
Author(s):  
D. Tawadrous ◽  
T. Skoretz ◽  
D. Thompson ◽  
S.A. Detombe ◽  
K. Van Aarsen
Keyword(s):  
Emergency Department ◽  
System Design ◽  
Practice Patterns ◽  
Cost Savings ◽  
Healthcare Budget ◽  
Coagulation Testing ◽  
Provider Practice ◽  
Targeted Testing ◽  
Laboratory Utilization ◽  
Baseline Cost

Introduction: In the context of a shrinking healthcare budget, poor physician cost awareness, and continued over-utilization of low-value tests in the emergency department, we re-designed our computerized order entry system to reduce the use of coagulation testing. Methods: A hospital-based prospective pre-post analysis following de-bundling of INRPTT testing in two academic hospital emergency departments (annual visits 140,000). All participants aged 18 years or older undergoing evaluation and/or treatment at either of during the period of August 1, 2015 to July 24, 2016 were included. Primary outcome is coagulation testing utilization rates and associated costs. Results: Unbundling INR and aPTT testing resulted in significantly decreased bundled INRPTT testing relative to baseline (INRPTT tests per patient per day: 0.60 [95% CI: 0.57-0.62] vs. 0.98 [95% CI: 0.98-0.99], p=0.000), with significantly increased targeted testing (INR tests per patient per day: 0.39 [95% CI: 0.37-0.42] vs. 0.00 [95% CI: 0.00-0.01], p=0.000; PTT tests per patient per day: 0.33 [95% CI: 0.30-0.36] vs. 0.01 [95% CI: 0.00-0.01], p=0.000). As a result of unbundling, there was a significant decrease in costs associated with coagulation testing relative to baseline (Cost per day: $958.52 [INRPTT $592.78+INR $183.91+PTT $181.83] vs. $1,074.50 [INRPTT $1,069.76+INR $2.06+PTT $2.68], p=0.000), realizing estimated daily and yearly savings of $115.98 and $42,332.70, respectively. Conclusion: Compared to baseline practice patterns, unbundling coagulation testing resulted in the reduction of coagulation testing suggesting system design and user workflows to be an integral factor to provider practice patterns. Given the significant cost-savings, we recommend institutions carefully re-evaluate their system design and user workflows to optimize emergency department laboratory utilization.

Reducing unnecessary testing in the emergency department: The case for INR and aPTT

CJEM ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. 534-541
Author(s):  
Davy Tawadrous ◽  
Sarah Detombe ◽  
Drew Thompson ◽  
Melanie Columbus ◽  
Kristine Van Aarsen ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Departments ◽  
Cost Savings ◽  
Clinical Decision ◽  
International Normalized Ratio ◽  
Educational Module ◽  
Patients Âgés ◽  
Coagulation Testing ◽  
Aggregate Rate ◽  
Routine Coagulation

ABSTRACTObjectiveRoutine coagulation testing is rarely indicated in the emergency department. Our goal is to determine the combined effects of uncoupling routine coagulation testing (i.e., international normalized ratio [INR]; activated partial thromboplastin time [aPTT]), disseminating an educational module, and implementing a clinical decision support system (CDSS) on coagulation testing rates in two academic emergency departments.MethodsA prospective pre-post study of INR-aPTT uncoupling, educational module distribution, and CDSS implementation in two academic emergency departments. All patients ages 18 years and older undergoing evaluation and treatment during the period of August 1, 2015, to November 30, 2017, were included. Primary outcome was coagulation testing utilization during the emergency department encounter. Secondary outcomes included associated costs, frequency of downstream testing, and frequency of blood transfusions.ResultsUncoupling INR-aPTT testing combined with educational module distribution and CDSS implementation resulted in significantly decreased coupled INR-aPTT testing, with significantly increased selective INR and aPTT testing. Overall, the aggregate rate of coagulation testing declined for both INR and aPTT testing (48 tests/100 patients/day to 26 tests/100 patients/day). There was a significant decrease in associated daily costs (median cost per day: $1048.32 v. $601.68), realizing estimated annual savings of $163,023 Canadian dollars (CAD). There was no signal of increased downstream testing or patient blood product requirements.ConclusionCompared to baseline practice patterns, our multimodal initiative significantly decreased coagulation testing, with meaningful cost savings and without evidence of patient harm. Clinicians and administrators now have a growing toolkit to target the plethora of low-value tests and treatments in emergency medicine.

Cost savings associated with decreased emergency department utilization by reporting emergency department visits to specialists

2017 ◽  
Vol 35 (10) ◽  
pp. 1578-1579 ◽  
Author(s):  
Brian J. Yun ◽  
Emily L. Aaronson ◽  
Esther Israel ◽  
Peter Greenspan ◽  
Sandhya Rao ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cost Savings ◽  
Emergency Department Visits ◽  
Emergency Department Utilization

Information Stewardship in Cloud Computing

2012 ◽  
pp. 185-202
Author(s):  
David Pym ◽  
Martin Sadler
Keyword(s):  
Mathematical Model ◽  
Cloud Computing ◽  
System Design ◽  
Service Providers ◽  
Cost Savings ◽  
Service Level ◽  
Information Services ◽  
Significant Part ◽  
Service Level Agreements ◽  
Economic Technology

Cloud computing ecosystems of service providers and consumers will become a significant part of the way information services are provided, allowing more agile coalitions, cost savings and improved service delivery. Existing approaches to information security do not readily extend to this complex multi-party world. The authors argue for a mathematical model-based framework for the analysis and management of information stewardship that makes explicit both the expectations and responsibilities of cloud stakeholders and the design assumptions of systems. Such a framework supports integrated economic, technology, and behavioural analyses, so providing a basis for a better understanding of the interplay between preferences, policies, system design, regulations, and Service Level Agreements. The authors suggest approaches to constructing economic, technology, and behavioural models and discuss the challenges in integrating them.

scholarly journals PARTNERING OF A FRONTLINE HEALTHCARE TEAM WITH A FAMILY ADVISOR TO IMPROVE ACUTE ASTHMA CARE IN A PEDIATRIC EMERGENCY DEPARTMENT: COST SAVINGS ANALYSIS

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e8-e8
Author(s):  
Catherine Rich ◽  
Alexander Sasha Dubrovsky
Keyword(s):  
Emergency Department ◽  
Cost Savings ◽  
Value Added ◽  
Healthcare Team ◽  
Diagnostic Code ◽  
Fee For Service ◽  
Process Redesign ◽  
Asthmatic Children ◽  
Physician Assessment ◽  
The Cost

Abstract BACKGROUND In 2016, a Canadian paediatric emergency department (ED) partnered with families in the co-design of a LEAN-based quality improvement (QI) project with the goal of increasing the proportion of asthmatic children receiving oral corticosteroids within one hour of arrival. LEAN projects aim to eliminate non-value-added process steps and to creatively solve problems as a team. Implemented changes included a process redesign with steroids given at the door and a revised asthma pathway increasing nurse autonomy prior to physician assessment. A sustained improvement (>12 months) was achieved, with asthmatic children consistently (>90%) receiving timely steroids within a mean time of 20 minutes. OBJECTIVES The objective of this study was to determine the cost savings of the improvements achieved by eliminating non-value-added process steps executed by physicians and nurses. The primary outcome measure was the number of documented care acts by physicians and nurses. DESIGN/METHODS Cases were identified by using the diagnostic code for asthma in the electronic medical record. This study included children 1 to 18 with Pediatric Respiratory Assessment Measure (PRAM) score ≥ 4 at triage. Patients who required admission were excluded. We reviewed a random sample of 20 to 30 charts monthly for 12 months, 6 months pre- and post-implementation of the revised asthma pathway. Physicians are remunerated on a fee-for-service basis and we modeled cost-savings of physician remunerations based on publically available physician fees. We assessed the number of documented nursing acts as a proxy for resource allocation in the ED given that the pathway increased nursing autonomy prior to physician assessment. RESULTS A total of 270 patients were included. With a simple process redesign aimed at getting children timely steroids at triage, the number of physician assessments decreased by 18%. In terms of physician billing, the cost savings were $24 per asthmatic patient in the ED. With >3000 asthma ED visits annually, the resulting estimated cost savings were >$72,000 per year. Even though increased nursing autonomy was part of the new process, documented nursing acts decreased by 10%. Moreover, although not included in the cost savings analysis, ED length of stay and admission rates both decreased. CONCLUSION Engaging frontline healthcare teams to co-design improvement initiatives with family partners in the ED is an excellent mechanism for leaders to sponsor. Frontline teams can implement creative and simple solutions that result in improved quality of care while also reducing unnecessary healthcare expenditures.

Implementation of an Emergency Department Computer System: Design Features That Users Value

2011 ◽  
Vol 41 (6) ◽  
pp. 693-700 ◽  
Author(s):  
Nicholas J. Batley ◽  
Hibah O. Osman ◽  
Amin A. Kazzi ◽  
Khaled M. Musallam
Keyword(s):  
Emergency Department ◽  
System Design ◽  
Computer System ◽  
Design Features ◽  
Computer System Design

Observational Study and Estimate of Cost Savings from Use of a Health Information Exchange in an Academic Emergency Department

2014 ◽  
Vol 46 (2) ◽  
pp. 250-256 ◽  
Author(s):  
Christine Marie Carr ◽  
Charles Samuel Gilman ◽  
Diann Marie Krywko ◽  
Haley Elizabeth Moore ◽  
Brenda J. Walker ◽  
...  
Keyword(s):  
Emergency Department ◽  
Observational Study ◽  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Cost Savings
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