Background For patients admitted to the Intensive care unit (ICU), diagnostic testing is often conducted routinely and at set intervals. However, compared to ordering tests in response to specific clinical questions, routine ordering may result in substantial unnecessary testing and be associated with adverse consequences including diversion of clinician time, iatrogenic anaemia and false positive results.
Aim To assess the effect of introducing a targeted testing intervention on the number of routine diagnostic tests performed in the ICU. Clinical outcomes included blood product use, length of stay and mortality.
Methods A single centre, before and after study conducted in the adult ICU of a tertiary hospital in Perth, Western Australia. The targeted testing intervention included a diagnostic testing guideline, clinician education, and feedback of tests conducted. All patients admitted in the 12 months before and following introduction of the intervention were compared using aggregated laboratory and other data obtained routinely and contained in clinical registries. The primary outcome was reduction in total tests conducted per ICU admission. Secondary outcomes included blood product ordered and intensive care unit and hospital length of stay and mortality.
Results All 2477 patients in the 12-month pre-intervention period and 2625 patients in the 12-month post-intervention period were included in the study. Clinical characteristics of the groups were similar. Routine diagnostic tests per ICU admission were 47.0 (SD 6.4) pre-intervention and 24.9 (6.5) post-intervention [mean reduction 22.1 (95% CI 16.6-27.6), P<0.0001], a difference of 49,452 fewer tests overall. Clinical outcomes including length of stay and mortality were unchanged.
Conclusion An ICU targeted testing intervention resulted in substantial decrease in routine diagnostic testing and ordered blood products without any detriment to clinical outcomes.