Quality Improvement Intervention for Reduction of Redundant Testing.
Laboratory data are critical to analyzing and improving clinical quality. In the setting of residual use of creatine kinase M and B isoenzyme testing for myocardial infarction, we assessed disease outcomes of discordant creatine kinase M and B isoenzyme +/troponin I (-) test pairs in order to address anticipated clinician concerns about potential loss of case-finding sensitivity following proposed discontinuation of routine creatine kinase and creatine kinase M and B isoenzyme testing. Time-sequenced interventions were introduced. The main outcome was the percentage of cardiac marker studies performed within guidelines. Nonguideline orders dominated at baseline. Creatine kinase M and B isoenzyme testing in 7496 order sets failed to detect additional myocardial infarctions but was associated with 42 potentially preventable admissions/quarter. Interruptive computerized soft stops improved guideline compliance from 32.3% to 58% (
Ducatman AM, Tacker DH, Ducatman BS, Long D, Perrotta PL, Lawther H, Pennington K, Lander O, Warden M, Failinger C, Halbritter K, Pellegrino R, Treese M, Stead JA, Glass E, Cianciaruso L, Nau KC. Quality Improvement Intervention for Reduction of Redundant Testing. Acad Pathol. 2017 May 28;4:2374289517707506. doi: 10.1177/2374289517707506. PMID: 28725791; PMCID: PMC5497914.