Decreased laboratory utilization in an “intensivist managed” surgical intensive care unit: A prospective study

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Abstract
Introduction: Phlebotomy accounts for 30% of blood transfused in the ICU. Organ dysfunction correlates with number of blood draws and total blood volume drawn. In order to improve quality of patient care, our SICU changed from a traditional "open" SICU to an "intensivist managed" SICU. We hypothesized that coordination of all orders by a dedicated "intensivist managed" surgical critical care service (SCCS) would decrease the number of labs performed, improve lab utilization, and decrease lab costs. Methods: We prospectively studied two distinct critical care delivery systems. The same intensivist team simultaneously treated two patient cohorts. One cohort was "intensivist managed" (only the SCCS wrote patient care orders). The "open" cohort had orders written by both the SCCS and the primary surgical service. Data were collected in a prospective, blinded fashion. Cohorts were compared by 24-hour APACHE II scores, number and type of daily labs, and lab costs. Student's t-test and chi-square were used. Results: Data were accrued for 1746 SICU patient days over a 4-month period. APACHE II scores were higher in the "intensivist managed" cohort. There were significantly fewer lab studies and lower costs per patient per SICU day in the "intensivist managed" patients. There was no difference in mortality. Table 1Decreased lab utilization and cost in an "intensivist managed" surgical ICU"Managed" cohort"Open" cohortp ValueNumber of patient SICU days998748APACHE 2 score at 24 hours15.9∗12.7p < 0.0001SICU mortality18/199 (9.1%)17/203 (8.4%)p = 0.81Complete blood count (CBC)1.29∗1.50p < 0.0001Electrolyte panels1.21∗1.47p < 0.0001Coagulation studies (PT/PTT)0.78∗1.03p < 0.0001Ca/Mg/Phos levels0.39∗0.80p < 0.0001Arterial blood gases (ABG)0.970.99p = 0.84Total daily lab costs$237∗$296∗p < 0.0001All lab data reported per patient per SICU day.∗Denotes statistically significant p < 0.0001. Conclusions: "Intensivist managed" SICU patients had fewer lab tests than patients in the "open" SICU system. There was no negative impact on mortality. This improved lab utilization cost $59,000 less over 4 months and has a projected yearly saving of $369,000.

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