Self-referrals versus physician referrals: What new patient visit yields an actual surgical case?

OBJECTIVESpine surgeons in the United States continue to be overwhelmed by an aging population, and patients are waiting weeks to months for appointments. With a finite number of clinic visits per surgeon, analysis of referral sources needs to be explored. In this study, the authors evaluated patient referrals and their yield for surgical volume at a tertiary care center.METHODSThis is a retrospective study of new patient visits by the spine surgery group at the Cleveland Clinic Center for Spine Health from 2011 to 2016. Data on all new or consultation visits for 5 identified spinal surgeons at the Center for Spine Health were collected. Patients with an identifiable referral source and who were at least 18 years of age at initial visit were included in this study. Univariate analysis was used to identify demographic differences among referral groups, and then multivariate analysis was used to evaluate those referral groups as significant predictors of surgical yield.RESULTSAfter adjusting for demographic differences across all referrals, multivariate analysis identified physician referrals as more likely (OR 1.48, 95% CI 1.04–2.10, p = 0.0293) to yield a surgical case than self-referrals. General practitioner referrals (OR 0.5616, 95% CI 0.3809–0.8278, p = 0.0036) were identified as less likely to yield surgical cases than referrals from interventionalists (OR 1.5296, p = 0.058) or neurologists (OR 1.7498, 95% CI 1.0057–3.0446, p = 0.0477). Additionally, 2 demographic factors, including distance from home and age, were identified as predictors of surgery. Local patients (OR 1.21, 95% CI 1.13–1.29, p = 0.018) and those 65 years of age or older (OR 0.80, 95% CI 0.72–0.87, p = 0.0023) were both more likely to need surgery after establishing care with a spine surgeon.CONCLUSIONSIn conclusion, referrals from general practitioners and self-referrals are important areas where focused triaging may be necessary. Further research into midlevel providers and nonsurgical spine provider’s role in these referrals for spine pathology is needed. Patients from outside of the state or younger than 65 years could benefit from pre-visit screening as well to optimize a surgeon’s clinic time use and streamline patient care.

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Safety of Concurrent Endoscopic Browlift and Blepharoplasty

Facial Plastic Surgery ◽

10.1055/s-0039-1695724 ◽

2019 ◽

Vol 35 (05) ◽

pp. 546-548

Author(s):

Nikolaus Hjelm ◽

Akshay Sanan ◽

Howard Krein ◽

Ryan N. Heffelfinger

Keyword(s):

Multivariate Analysis ◽

Autoimmune Disease ◽

Comparative Study ◽

Care Center ◽

Univariate Analysis ◽

Tertiary Care ◽

Smoking History ◽

Complication Rates ◽

Increased Risk ◽

Retrospective Comparative Study

AbstractThe objective of the study was to evaluate the clinical safety of endoscopic browlift alone or in combination with blepharoplasty as a treatment for the aging face. This is a retrospective comparative study from 2007 to 2016 at a single tertiary care center. A consecutive sample of patients undergoing surgery for aging of the upper face was included in the study. Surgeries deemed to be inclusive were endoscopic browlift, upper blepharoplasty, and lower blepharoplasty. In total, 46 patients undergoing endoscopic browlift with concurrent blepharoplasty were included. Patient demographics, past medical history, follow-up, and any complications related to their surgery were studied up to 90 months postoperatively. Combination of endoscopic browlift with blepharoplasty did not increase the risk of complications on univariate analysis (p = 0.735). There were no differences in complication rates on univariate analysis of patients with a smoking history, diabetes, or autoimmune disease (p = 0.111, p = 0.575, p > 0.999, respectively). Furthermore, there was no difference between groups in complication rates, smoking history, diabetes, or autoimmune disease (p = 0.735, p = 0.181, p = 0.310, p = 0.218, respectively). Smoking had an insignificant increased risk of complication as compared with nonsmokers on multivariate analysis (odds ratio [OR] = 4.526; p = 0.073). Increasing age was slightly associated with fewer complications on multivariate analysis in this patient cohort (OR = 0.939; p = 0.048). By combining endoscopic browlift with a concomitant blepharoplasty, the goals of the patient and the standards of the surgeon can be effectively and safely achieved. Analysis of complications from 46 combined cases at our institution asserts that this is a safe operation. Smoking status was the only observed predictor for postoperative complications. This was a level of evidence 3, retrospective comparative study.

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Impact of Rapid PCR Influenza Testing on the Rate of Inpatient Admissions During Influenza Season at a Tertiary-Care Center

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.830 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s263-s264

Author(s):

Jordan Polistico ◽

Avnish Sandhu ◽

Teena Chopra ◽

Erin Goldman ◽

Jennifer LeRose ◽

...

Keyword(s):

Influenza Season ◽

Care Center ◽

Tertiary Care ◽

The United States ◽

Turnaround Time ◽

Care Hospital ◽

Tertiary Care Center ◽

Pediatric Hospital ◽

Rapid Pcr ◽

The Impact

Background: Influenza causes a high burden of disease in the United States, with an estimate of 960,000 hospitalizations in the 2017–2018 flu season. Traditional flu diagnostic polymerase chain reaction (PCR) tests have a longer (24 hours or more) turnaround time that may lead to an increase in unnecessary inpatient admissions during peak influenza season. A new point-of-care rapid PCR assays, Xpert Flu, is an FDA-approved PCR test that has a significant decrease in turnaround time (2 hours). The present study sought to understand the impact of implementing a new Xpert Flu test on the rate of inpatient admissions. Methods: A retrospective study was conducted to compare rates of inpatient admissions in patients tested with traditional flu PCR during the 2017–2018 flu season and the rapid flu PCR during the 2018–2019 flu season in a tertiary-care center in greater Detroit area. The center has 1 pediatric hospital (hospital A) and 3 adult hospitals (hospital B, C, D). Patients with influenza-like illness who presented to all 4 hospitals during 2 consecutive influenza seasons were analyzed. Results: In total, 20,923 patients were tested with either the rapid flu PCR or the traditional flu PCR. Among these, 14,124 patients (67.2%) were discharged from the emergency department and 6,844 (32.7%) were admitted. There was a significant decrease in inpatient admissions in the traditional flu PCR group compared to the rapid flu PCR group across all hospitals (49.56% vs 26.6% respectively; P < .001). As expected, a significant proportion of influenza testing was performed in the pediatric hospital, 10,513 (50.2%). A greater reduction (30% decrease in the rapid flu PCR group compared to the traditional flu PCR group) was observed in inpatient admissions in the pediatric hospital (Table 1) Conclusions: Rapid molecular influenza testing can significantly decrease inpatient admissions in a busy tertiary-care hospital, which can indirectly lead to improved patient quality with easy bed availability and less time spent in a private room with droplet precautions. Last but not the least, this testing method can certainly lead to lower healthcare costs.Funding: NoneDisclosures: None

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DEPRESSION IN OLDER ADULTS- A STUDY ON PATIENTS VISITING A TERTIARY CARE CENTER IN NORTH INDIA

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i5.238 ◽

2019 ◽

Vol 3 (5) ◽

Author(s):

Indrajeet Singh Gambhir ◽

Amit Raj Sharma ◽

Sankha Shubhra Chakrabarti ◽

Upinder Kaur ◽

Bindu Prakash

Keyword(s):

Logistic Regression ◽

Marital Status ◽

Short Form ◽

Care Center ◽

Univariate Analysis ◽

Tertiary Care ◽

Depression Score ◽

North India ◽

Geriatric Depression ◽

Depression Prevalence

Background: Depression is the commonest psychiatric disorder in the elderly. We attempted to analyze the prevalence and correlates of depression in the north Indian elderly. Methods: An observational study was carried out taking cases from patients attending the geriatric clinic for the first time. Depression was diagnosed by the Geriatric Depression Score short form (≥5). Various epidemiological parameters were assessed in 504 subjects (M = 304, F = 200; mean age = 66.47±13.71 years). Results: Depression prevalence was 45%. A significant correlation was found between depression prevalence and gender (F>M, p=0.011), level of education (p=0.002), marital status (p<0.001) and insomnia (p<0.001) on univariate analysis. On binomial logistic regression analysis, marital status (widowed > married, p=0.008) and insomnia (present > absent, p<0.001) showed significant correlation with depression prevalence. Conclusion: Our study highlights certain epidemiological aspects of depression in the aged Indian population presenting to the tertiary hospital. Spousal loss and insomnia are documented as possible depression risks but longitudinal studies are needed to confirm the same. Keywords: Geriatrics, Depression, Epidemiology, Geriatric Depression Score, Prevalence, Logistic Regression

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Use of the Fluoride Varnish Billing Code in a Tertiary Care Center Setting

Journal of Primary Care & Community Health ◽

10.1177/2150132720913736 ◽

2020 ◽

Vol 11 ◽

pp. 215013272091373

Author(s):

Peter Kim ◽

Jeanette M. Daly ◽

Sharon Berkowitz ◽

Barcey T. Levy

Keyword(s):

Teaching Hospital ◽

Task Force ◽

Care Center ◽

Tertiary Care ◽

The United States ◽

Fluoride Varnish ◽

Successful Implementation ◽

Clinical Notes ◽

Tertiary Teaching ◽

Tertiary Teaching Hospital

Introduction: Dental caries is the most common chronic disease in children from birth through 5 years of age. Application of fluoride varnish (FV) is recommended for children younger than 6 years every 3 to 6 months by the United States Preventive Services Task Force. The purposes of this study were to (1) assess use and reimbursement of Current Dental Terminology (CDT) D1206 and Current Procedural Terminology (CPT) 99188 codes, which are the billing codes for FV application; (2) determine when and by whom each FV code was used; and (3) summarize the associated clinical notes. Methods: Using the electronic medical record data warehouse from a single tertiary teaching hospital and its affiliated primary care clinics, the dates of service, departments, provider names, and patient identifiers associated with codes CDT D1206 and CPT 99188 were collected. The content of clinical notes was reviewed and summarized. The study period was from May 1, 2009 through May 17, 2019. Results: During the 10-year time period, CDT D1206 was used 5 times and CPT 99188 was used 35 times. FV was applied exclusively during well-child visits. Only pediatricians, and no family physicians, applied FV in this setting. Discussion: A single pediatrician championing for FV application increased both the completion of procedure and the appropriate billing in 2019. Conclusion: FV application has been likely underutilized in this Midwestern tertiary teaching hospital and its affiliated clinics. For both family medicine and pediatric offices, an advocate for caries prevention is likely needed for successful implementation of FV application at well-child visits.

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375. Cryptococcal Antigenemia in Advanced HIV Infection

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.448 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S196-S196

Author(s):

Jatin Ahuja ◽

Manish Soneja ◽

Naveet Wig ◽

Immaculata Xess ◽

Ashutosh Biswas ◽

...

Keyword(s):

Multivariate Analysis ◽

Care Center ◽

Tertiary Care ◽

Latex Agglutination ◽

Cd4 Count ◽

North India ◽

World Health ◽

P Value ◽

The Mean

Abstract Background Diagnostic importance of asymptomatic cryptococcal antigenemia is being increasingly recognized in the last few years. Recently, WHO (World Health Organization) has recommended routine screening of CrAg (cryptococcal antigen) among PLHA with CD4 ≤100/mm3, albeit this procedure is not yet adopted by many developing countries including India. Methods We conducted a prospective observational study in a large tertiary care center of North India, upon ethical clearance. Latex agglutination test was performed to assess serum CrAg levels, followed by the lumbar puncture for detection of CrAg levels in the CSF. We analyzed the prevalence and treatment outcomes of cryptococcal antigenemia among PLHA with CD4 ≤ 100 cells/mm3. Detailed clinical examination was conducted, with follow-up of upto 3 months. Multivariate analysis was performed for the estimation of risk factors. Results The mean age (years) and BMI (kg/m2) of all the participants were 41.4 ± 11.2 and 22.1 ± 2.6, respectively. Notably, the mean CD4 count (cu.mm) at the time of recruitment was 62.3 ± 20.5. Noteworthy, 62 (60.8%) of the patients were ART naïve. We found 9.8% (n = 10) of the patients were positive for serum CrAg, and only 2.9% (n = 3) had clinical features of meningitis and 6.8% (n = 7) were asymptomatic (subclinical) CrAg positive. Strikingly, 3.9% (n = 4) of the asymptomatic cryptococcal antigenemia patients were also positive for CrAg in CSF, with 1.9% (n = 2) were only serum CrAg positive, and 1 patient was lost to follow-up (Graph 1). Multivariate analysis revealed that patients with long duration of HIV (P = 0.04), headache symptoms (P = 0.004) and possessing features of meningismus (P value=0.08) are more likely to be CrAg positive. Conversely, patients on fluconazole were protective against cryptococcal antigenemia (P = 0.1) as shown in Table 1. Overall mortality observed was 11.3% among advanced HIV patients. Moreover, mortality in CrAg-positive patients was 33.3% in comparison to CrAg-negative patients who had 9% (P = 0.06) in 3-months follow-up. Conclusion Cryptococcal antigenemia is common (9.8%) among patients with CD4 count ≤100/mm3 in India. Screening for CrAg should be made routine for PLHA with CD4 count ≤100/mm3 and if required preemptive treatment to be given in this regard. Disclosures All authors: No reported disclosures.

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573. Enterococcal Bacteremia in a Tertiary Care Center in Mexico: A Retrospective Analysis Focus on Vancomycin-Resistant E. faecium and Ampicillin-Resistant E. faecalis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.642 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S270-S271

Author(s):

Bruno A Lopez Luis ◽

Darwin Lambraño-Castillo ◽

Edgar Ortiz-Brizuela ◽

Andrea Ramirez-Fontes ◽

Yanet Estrella Tovar-Calderon ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Care Center ◽

Strong Association ◽

Tertiary Care ◽

Acquired Resistance ◽

Venous Catheter ◽

Vana Gene ◽

Vancomycin Resistant ◽

History Of Use

Abstract Background The primary pathogens in genera enterococcus are E. faecalis and E. faecium, increasing acquired resistance to glycopeptides and β lactamic has done the management more challenging. We aimed to describe the risk factors for acquisition of bacteremia for vancomycin-resistant E. faecium (VRE) and ampicillin-resistant E. faecalis (ARE) and the 30-day mortality in comparison to susceptible enterococcal bloodstream infection (BSI) Methods From 2007- 2017 medical records of all BSI for E. faecalis and E. faecium were evaluated. Risk factor for acquisition of VRE and ARE as well as the significant variables associated with 30-day mortality for enterococcal BSI were determined by univariate and multivariate analysis. The molecular mechanism of VRE was performed by PCR Results There were 192 patients with E. faecium BSI of which 107(56%) patients had VRE BSI with 94% VRE strains expressing vanA gene. The index bacteremic episodes were classified as nosocomial o healthcare associated in 99%, 102(95%) had hospitalization 1 year before and 101(94%) history of use of antibiotics 3 months earlier, the multivariate analysis showed duration of the previous hospitalization >10 days (OR, 80.18; 95% CI, 1.81–634), use of central venous catheter [OR, 11.15; 95% CI, 2.48–50.2), and endotracheal cannula [OR, 17.91; 95% CI, 1.22–262) as significant associated variables. The mortality for VRE was greater than susceptible E. faecium (60% vs. 24%, P < 0.001). The only factors for 30-day mortality for E. faecium BSI in the multivariate analysis was APACHE ll score [OR,1.45; 95% CI, 1.26–1.66) and patients with chemotherapy of cancer. (OR, 3.52; 95% CI, 1.09–11.39). 147 patients had E. faecalis BSI of which 18 (11%) patients had ARE, we did not find relevant clinical differences of ARE in comparison with ampicillin-susceptible E. faecalis, neither in risk factors for acquisition of ARE nor 30-day mortality [7(39%) vs. 38(29%), P = 0.58] in uni and multivariate analysis Conclusion Our evaluation showed in a period of 10 years that VRE expressing vanA gene had a strong association with patients with previous nosocomial exposure. Severely ill patients and cancer patients on chemotherapy during the bacteremic episode were the variables more associated with 30-day mortality. ARE is yet of low prevalence and less known, constant surveillance about it is warranted Disclosures All authors: No reported disclosures.

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Factors associated with asthma expression in adolescents

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37562017000000078 ◽

2018 ◽

Vol 44 (1) ◽

pp. 12-17 ◽

Cited By ~ 1

Author(s):

Silvia de Souza Campos Fernandes ◽

Dirceu Solé ◽

Paulo Camargos ◽

Cláudia Ribeiro de Andrade ◽

Cássio da Cunha Ibiapina

Keyword(s):

Multivariate Analysis ◽

Public Schools ◽

Care Center ◽

Univariate Analysis ◽

Health Care Facilities ◽

Tobacco Smoke Exposure ◽

Farm Animals ◽

Analysis Model ◽

Factors Associated ◽

Asthma Symptoms

ABSTRACT Objective: To evaluate risk factors associated with asthma symptoms in adolescents in the 13- to 14-year age bracket. Methods: This was a cross-sectional study involving adolescents enrolled in randomly selected public schools in the city of Belo Horizonte, Brazil, and conducted with the use of the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and its supplementary module for risk factor assessment. The ISAAC questionnaire was completed by the students themselves, whereas the supplementary questionnaire was completed by their parents or legal guardians. Variables showing p ≤ 0.25 in the univariate analysis were included in the multivariate analysis. Stepwise regression with backward elimination was used for variable selection. Results: We evaluated 375 adolescents, 124 (33.1%) of whom had asthma symptoms. The final multivariate analysis model revealed that asthma symptoms were associated with birth weight < 2,500 g (p < 0.001), day care center or nursery attendance (p < 0.002), maternal history of asthma (p < 0.001), contact with animals during the first year of life (p < 0.027), current contact with animals outside the home (dogs, cats, or farm animals; p < 0.005), and more than 20 cigarettes per day smoked by parents or other household members (p < 0.02). Conclusions: Exposure to animals in and outside the home is associated with asthma symptoms, as is environmental tobacco smoke exposure. Families, health professionals, and administrators of health care facilities should take that into account in order to prevent asthma and reduce asthma morbidity.

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Exceeding Pitch Count Recommendations In Youth Baseball Increases The Elbow Injuries

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00126 ◽

2018 ◽

Vol 6 (7_suppl4) ◽

pp. 2325967118S0012

Author(s):

Tetsuya Matsuura ◽

Toshiyuki Iwame ◽

Koichi Sairyo

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Multivariate Analysis ◽

Univariate Analysis ◽

The United States ◽

Injury Incidence ◽

Elbow Pain ◽

Increased Risk ◽

Youth Baseball ◽

Elbow Injuries

Objectives: With the incidence of Little League elbow increasing, pitch limit recommendations for preventing throwing injuries have been developed in the United States and Japan. In 1995, the Japanese Society of Clinical Sports Medicine announced limits of 50 pitches per day and 200 pitches per week to prevent throwing injuries in younger than 12 years old. However the relationship between pitch limit recommendation and elbow injuries among pitchers has not been adequately studied. The aim of our study was to evaluate the association between pitch counts and elbow injuries in youth pitchers. Methods: A total of 149 pitchers without prior elbow pain were observed prospectively for 1 season to study injury incidence in relation to specific risk factors. Average age was 10.1 years (range, 7-11 years). One year later, all pitchers were examined by questionnaire. Subjects were asked whether they had experienced any episodes of elbow pain during the season. The questionnaire was also used to gather data on pitch counts per day and per week, age, number of training days per week, and number of games per year. We investigated the following risk factors for elbow injury: pitch counts, age, position, number of training days per week, and number of games per year. Data were analyzed by multivariate logistic regression models and presented as odds ratio (OR) and profile likelihood 95% confidence interval (CI) values. The likelihood-ratio test was also performed. A two-tailed P value of less than .05 was considered significant. All analysis was done in the SAS software package (version 8.2). Results: Of the 149 subjects, 66 (44.3%) reported episodes of pain in the throwing elbow during the season. 1. Analysis for pitch count per day Univariate analysis showed that elbow pain was significantly associated with more than 50 pitches per day. Multivariate analysis showed that more than 50 pitches per day (OR, 2.44; 95% CI, 1.22-4.94), and more than 70 games per year (OR, 2.47; 95% CI, 1.24-5.02) were risk factors significantly associated with elbow pain. Age and number of training days per week were not significantly associated with elbow pain. 1. Analysis for pitch count per week Univariate analysis showed that elbow pain was significantly associated with more than 200 pitches per week. Multivariate analysis showed that more than 200 pitches per week (OR, 2.04; 95% CI, 1.03-4.10), and more than 70 games per year (OR, 2.41; 95% CI, 1.22-4.87) were risk factors significantly associated with elbow pain. Age was not significantly associated with elbow pain. Conclusion: A total of 44.3% of youth baseball pitchers had elbow pain during the season. Multivariable logistic regression revealed that elbow pain was associated with more than 50 pitches per day, more than 200 pitches per week, and more than 70 games per year. Previous studies have revealed the risk factor with the strongest association to injury is pitcher. Our data suggest that compliance with pitch limit recommendations including limits of 50 pitches per day and 200 pitches per week may be protective against elbow injuries. Those who played more than 70 games per year had a notably increased risk of injury. With increasing demand on youth pitchers to play more, there is less time for repair of bony and soft tissues in the elbow. In conclusion, among youth pitchers, limits of 50 pitches per day, 200 pitches per week, and limits of 70 games per year may protect elbow injuries.

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Plasmacytoma: 10 years experience at a tertiary care center in India.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e18573 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e18573-e18573

Author(s):

Saphalta Baghmar ◽

Vinod Raina ◽

Atul Sharma ◽

Lalit Kumar

Keyword(s):

Local Control ◽

Vertebral Column ◽

Care Center ◽

Univariate Analysis ◽

Tertiary Care ◽

Initial Response ◽

Rank Test ◽

Solitary Plasmacytoma ◽

Kaplan Meier ◽

Plasma Cell Dyscrasias

e18573 Background: To evaluate the clinical features, diagnoses, prognostic factors, progression to MM of the patients of solitary plasmacytoma (SP) treated at AIIMS in last 10 years(2001-2010). Methods: From 2001-2010, we identified 57 patients with SP. OS, EFS, progression to myeloma were calculated using the Kaplan-Meier method and log rank test. Results: Out of 57 patients; 48 patients were evaluable. The M:F ratio was 3.5:1 with the median age of 49 years. The primary site was osseous(SBP) in 49 patients, extramedullary(EMP) in 8; 5 lesions were located in the upper respiratory passages, ie nasal cavity and maxillary sinus and rest of the 3 were one each in bronchus, gluteal region and intracranial. 43.8% of the lesions involved the vertebral column. The thoracic spine was the single most commonly involved site (12/57 patients). Out of 25 patients with lesions in vertebral column, 12 presented with paraparesis. Monoclonal protein was present in 48% patients and Urine M- Band in additional 2 patients. Treatment consisted of RT [45 Gy (8-50 Gy)] alone in 27, excision in 2 and excision and RT(n=9) and combined modality(n=10). The median follow-up was 28 months(range 3-160 months). Local control was achieved in 41(85%) while progressive disease was seen in 4. Serum M protein became undetectable after treatment in 60% patients. 17(41%) patients progressed to MM after initial response. The median duration of progression to MM was 21 months. Even though there was a trend towards a better EFS and OS for EMP than SBP, in univariate analysis this was not statistically significant. Patients having vertebral lesion showed trend towards progression to MM (p=.057). 5 yr EFS & OS were 44.4% and 89 % respectively. Median EFS and OS were 38 and 122 months respectively. 5 yr survival rate in patients who developed MM and those who did not were 81% and 100% respectively. None of the baseline characteristics were predictive of survival. Conclusions: Out of 1129 patients of plasma cell dyscrasias registered between 2001-2010; 5% were of SP. Bone was the most common site. Attainment of local control is the predictor of significant EFS (p<0.0001) and OS (p<0.05). Progression to MM is the commonest pattern of failure. Vertebrae involvement was predictor for disease progression to MM.

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Duplicate Type and Screen Testing: Waste in the Clinical Laboratory

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2016-0629-oa ◽

2017 ◽

Vol 142 (3) ◽

pp. 358-363

Author(s):

Margaret L. Compton ◽

Penny C. Szklarski ◽

Garrett S. Booth

Keyword(s):

Clinical Laboratory ◽

Care Center ◽

Tertiary Care ◽

The United States ◽

Transfusion Medicine ◽

Laboratory Cost ◽

System A ◽

Medicine Service ◽

Additional Education ◽

Clinical Laboratory Testing

Context.— In the United States, approximately $65 billion dollars is spent per year on clinical laboratory testing, of which 20% to 30% of all testing is deemed inappropriate. There have been multiple studies in the field of transfusion medicine regarding evidence-based transfusion practices, but limited data exist regarding inappropriate pretransfusion testing and its financial and clinical implications. Objective.— To assess duplicative testing practices in the transfusion medicine service. Design.— A 24-month retrospective review was performed at a 1025-bed tertiary care center, identifying all duplicate type and screen (TS) tests performed within 72 hours of the previous TS. Duplicative testing was classified as appropriate or inappropriate by predetermined criteria. The level of underordering was analyzed through a query of the electronic event reporting system. A cost analysis was performed to determine the financial impact of inappropriate duplicative TS. Results.— The mean rate of inappropriate, duplicative TS orders was 4.13% (standard deviation ± 4.09%). Rates of inappropriate ordering ranged from 0.01% to 15.5% depending on the clinical service and did not correlate with volume of tests ordered. There were 8 reported cases of delayed blood delivery due to lack of a valid TS during the study period, demonstrating that underordering is also a harmful practice. The laboratory cost of inappropriate testing for the study period was $80,434, and phlebotomy costs were $45,469. Conclusions.— Our study demonstrates that inappropriate TS ordering is costly, both financially and clinically. By evaluating the percentage of inappropriate TS tests by clinical services, we have identified services that may benefit from additional education and technologic intervention.

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