Reducing Inappropriate ESR Testing with Computerized Clinical Decision Support

Overview

Journal BMJ Qual Improv Rep

Date 2016 Apr 21

PMID 27096092

Citations 9

Authors

Stephanie Gottheil

Ekta Khemani

Katherine Copley

Michael Keeney

Jeff Kinney

Ian Chin-Yee

Alan Gob

Affiliations

Soon will be listed here.

Abstract

Laboratory test overutilization increases health care costs, leads to unwarranted investigations, and may have a negative impact on health outcomes. The American Society of Clinical Pathology, in its Choosing Wisely Campaign, advocates that inflammation be investigated with C-reactive protein (CRP) instead of Erythrocyte Sedimentation Rate (ESR). London Health Sciences Centre (LHSC), a tertiary care hospital organization in Ontario, Canada, set a goal to reduce inappropriate ESR orders by 50%. After developing appropriateness criteria for ESR, we used a series of PDSA cycles to reduce inappropriate ESR ordering and analyzed our results with an interrupted time series design. Our intervention began with an educational bulletin and moved to city-wide implementation of computerized Clinical Decision Support (CDS). After implementation, ESR orders decreased by 40% from 386 orders per week to 241 orders per week. Our results are supported by previous literature on the effectiveness of CDS in reducing overutilization and suggest that provider habit is a significant contributor to inappropriate ordering.

Citing Articles

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