scholarly journals Improving laboratory test utilisation at the multihospital Yale New Haven Health System

2019 ◽  
Vol 8 (3) ◽  
pp. e000689 ◽  
Author(s):  
Roa Harb ◽  
David Hajdasz ◽  
Marie L Landry ◽  
L Scott Sussman
Keyword(s):  
Laboratory Test ◽  
Cost Savings ◽  
Physician Education ◽  
Daily Routine ◽  
New Haven ◽  
Order Entry ◽  
Utilisation Management ◽  
Test Order ◽  
Physician Order Entry ◽  
The Impact

BackgroundWaste persists in healthcare and negatively impacts patients. Clinicians have direct control over test ordering and ongoing international efforts to improve test utilisation have identified multifaceted approaches as critical to the success of interventions. Prior to 2015, Yale New Haven Health lacked a coherent strategy for laboratory test utilisation management.MethodsIn 2015, a system-wide laboratory formulary committee was formed at Yale New Haven Health to manage multiple interventions designed to improve test utilisation. We report here on specific interventions conducted between 2015 and 2017 including reduction of (1) obsolete or misused testing, (2) duplicate orders, and (3) daily routine lab testing. These interventions were driven by a combination of modifications to computerised physician order entry, test utilisation dashboards and physician education. Measurements included test order volume, blood savings and cost savings.ResultsTesting for a number of obsolete/misused analytes was eliminated or significantly decreased depending on alert rule at order entry. Hard stops significantly decreased duplicate testing and educational sessions significantly decreased daily orders of routine labs and increased blood savings but the impact waned over time for select groups. In total, we realised approximately $100 000 of cost savings during the study period.ConclusionThrough a multifaceted approach to utilisation management, we show significant reductions in low-value clinical testing that have led to modest but significant savings in both costs and patients’ blood.

Financial Impact of an Automated Oncology Dose-Rounding Initiative: One-Year Analysis

2021 ◽  
pp. 805-810
Author(s):  
Jacqueline C. Dela-Pena ◽  
Katie A. Eschenburg ◽  
Vincent W. LaRocca ◽  
Dipale Patel ◽  
Shannon M. Hough
Keyword(s):  
Cost Savings ◽  
Health Care Expenditures ◽  
Cytotoxic Agents ◽  
Computerized Physician Order Entry ◽  
Order Entry ◽  
Minimal Impact ◽  
Drug Expenditures ◽  
Physician Order Entry ◽  
The Impact ◽  
Rounding Algorithm

PURPOSE Infusion drugs are regarded as one of the high-cost health care expenditures. One approach to decrease drug expenditures is by dose-rounding biologics and cytotoxic agents. The Hematology/Oncology Pharmacy Association recommends that biologic and cytotoxic agents are rounded to the nearest vial size if they are within 10% of the ordered dose. The purpose of this initiative is to determine the impact of an automated dose-rounding algorithm on drug expenses. METHODS The dose-rounding algorithm was developed and integrated into the computerized physician order entry system for automated dose rounding to minimize impact on current workflow and to reduce medication errors. Twenty-four medications were preselected for dose rounding and included in the analysis. Ordered doses were automatically rounded to the nearest vial size if the dose was within 10% of the original dose. Prescribers then either reviewed and signed the rounded dose or manually entered the nonrounded dose. Cost savings were calculated as drug expense savings from doses rounded down. RESULTS From July 2018 to June 2019, 10,206 doses of the selected medications were administered. Dose rounding occurred in 5,069 doses (49.7%). All 24 medications within the initiative were administered within the time of analysis. Of the rounded doses administered, 2,516 (49.6%) were rounded down to a commercially available vial size. Using wholesale acquisition cost pricing, the drug expense savings was approximately $3.6 million US dollars (USD). The medications with the highest savings were trastuzumab and ipilimumab, with annual savings of $756,780 USD and $494,517 USD, respectively. CONCLUSION The automated dose-rounding algorithm at Michigan Medicine reduced drug expenditures substantially, and its integration within the computerized physician order entry system had minimal impact on current workflow.

scholarly journals Impact of a Pharmacist-Driven Protocol to Improve Drug Allergy Documentation at a University Hospital

2013 ◽  
Vol 48 (4) ◽  
pp. 302-307 ◽  
Author(s):  
Christopher Burrell ◽  
Candy Tsourounis ◽  
David Quan ◽  
Vicki Jue ◽  
Eunice Tam ◽  
...  
Keyword(s):  
Drug Allergy ◽  
Age Groups ◽  
Substantial Improvement ◽  
University Hospital ◽  
Order Entry ◽  
Post Intervention ◽  
Pediatric Services ◽  
Physician Order Entry ◽  
The Impact

Background An internal evaluation of the inpatient pharmacy order entry database ( WORx) at a university hospital revealed that the nature of the reaction was documented for only 47% of patients with reported drug allergies/intolerance. Insufficient documentation of drug allergy/intolerance may result in administration of drugs that should not be prescribed. Similarly, valuable agents that should be used may not be prescribed due to an unnecessary fear of adverse drug reaction. More complete description of drug allergy/intolerance may result in more correct prescribing of medications. Objective Evaluate the impact of a pharmacist-driven protocol on the quality of drug allergy/intolerance documentation. Methods Four pre-intervention evaluations were conducted every 2 weeks documenting the completeness of drug allergy/intolerance information in the pharmacy order entry database. One week following the implementation of a pharmacist-driven protocol intended to improve the completeness of drug allergy/intolerance information, a series of 4 postintervention evaluations was repeated. Proportional analysis of pre- and postinterventional data was performed to evaluate the effectiveness of the intervention. Results A total of 1,686 allergies from 2,174 patients were reviewed pre and post intervention. The frequency of complete drug allergy/intolerance documentation pre intervention was 52% to 62%. Following implementation of the hospitalwide, pharmacist-driven protocol, this rate increased to 60% to 76%. Pediatric services demonstrated the most substantial improvement, increasing from 53% to 79% to 67% to 93%. Blank reaction fields decreased by 10% in both age groups. Conclusion A pharmacy-driven initiative intended to improve the completeness of drug allergy/intolerance documentation was associated with modest success. Other mechanisms, including electronic health record systems with computerized physician order entry and decision support, are needed to improve the completeness of drug allergy/intolerance information.

scholarly journals The impact of computerized physician order entry on prescription orders: A quasi-experimental study in Iran

2017 ◽  
Vol 31 (1) ◽  
pp. 396-400 ◽  
Author(s):  
Mohammad Khammarnia ◽  
Roxana Sharifian ◽  
Farid Zand ◽  
Omid Barati ◽  
Ali Keshtkaran ◽  
...  
Keyword(s):  
Experimental Study ◽  
Computerized Physician Order Entry ◽  
Order Entry ◽  
Quasi Experimental ◽  
Physician Order Entry ◽  
The Impact

scholarly journals Scoping Review of Computerized Physician Order Entry Systems in Reducing Medical Errors

2021 ◽  
Author(s):  
Gisoo Alizadeh ◽  
Adineh Jafarzadeh ◽  
Mohammad Farough Khosravi
Keyword(s):  
Medication Errors ◽  
Medical Errors ◽  
Scoping Review ◽  
Positive Impact ◽  
Research Question ◽  
Economic Consequences ◽  
Order Entry ◽  
Positive Effects ◽  
Physician Order Entry ◽  
The Impact

Background: Medical errors have dramatic clinical and economic consequences. Using various information technology can reduce medical errors and improve services’ quality via preventing medical errors. In this study, the role of a computerized medical order entry system was investigated in reducing medical errors. Methods: This study was conducted as a scoping review. The research question was formulated; then, the inclusion and exclusion criteria, keywords (such as medical errors, adverse event, physician order entry system and control) and search strategy were determined. International databases(Scopus, ProQuest, and PubMed) and manual searches were used. The studies that had the inclusion criteria were entered into the study and were evaluated qualitatively, then information of studies was extracted and summarized. Results: In total, 16 studies were included. Most studies were about medication errors and adverse medication events. So, it is possible to claim more confidently about reducing medication errors to adverse medication events, since in studies, the impact of this system on medication errors had been further discussed. Some studies have pointed to an increase in error reports due to better checking and error entry with this system, and in general, the positive impact of this action has been mentioned in minimizing errors, especially medication errors and adverse medication events. Positive and significant effects have also been reported on prescribing errors, especially medication prescriptions. Conclusion: Computerization of medical orders through its positive effects, can be considered a useful and appropriate intervention in increasing patient safety if implemented completely and correctly.

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