The Cost of Pre-Analytical Errors in INR Testing at a Tertiary-Care Hospital Laboratory: Potential for Significant Cost Savings.

BACKGROUND: Preanalytical errors account for most laboratory errors. Although the frequencies of preanalytical errors are well characterized in the literature, little is known regarding the costs of these errors to the laboratory. OBJECTIVE: To analyze costs associated with preanalytical errors associated with the international normalized ratio (INR) test. METHODS: We performed a retrospective analysis of INR requests associated with preanalytical error codes from January 2009 through September 2013. Preanalytical error types were those related to order entry (no specimen collected) and those unrelated to order entry (insufficient specimen quantity or specimen-integrity concerns). We calculated the cost of analysis of a specimen and the cost of investigating errors. RESULTS: During the study period, there were 557,411 INR requests, 13.1% of which were associated with a preanalytical error code. The total annual cost of INR testing was USD $379,222.50. Investigation and reporting of preanalytical errors not related to order entry represented 10.5% of our annual INR testing budget (USD $39,939.00). CONCLUSIONS: Minimizing preanalytical errors has the potential to result in significant cost savings.

Major reductions in unnecessary aspartate aminotransferase and blood urea nitrogen tests with a quality improvement initiative.

BACKGROUND/CONTEXT: Unnecessary laboratory testing leads to considerable healthcare costs. Aspartate aminotransferase (AST), commonly ordered with alanine aminotransferase (ALT) and blood urea nitrogen (BUN), commonly ordered with creatinine (Cr), often add little value to patient management at significant cost. We undertook a choosing wisely based quality improvement initiative to reduce the frequency of testing. OBJECTIVES: To reduce the ratio of AST/ALT and BUN/Cr to less than 5% for all inpatient and outpatient test orders. MEASURES: Absolute number and ratio of AST/ALT and BUN/Cr; AST, ALT, BUN and Cr tests per 100 hospital days; projected annualised cost savings and monthly acute inpatient bed days. IMPROVEMENTS: We created guidelines for appropriate indications of AST and BUN testing, provided education with audit and feedback and removed AST and BUN from institutional order sets. IMPACT/RESULTS: The ratios of AST/ALT and BUN/Cr decreased significantly over the study period (0.37 to 0.14, 0.57 to 0.14, respectively), although the goal of 0.05 was not achieved due to a delay in adopting the choosing wisely strategies during the study time period by some inpatient units. The number of tests per 100 hospital days decreased from 20 to 7 AST (95% CI 19 to 20.5, 5.6 to 8.7, p<0.001) and from 72 to 17 BUN (95% CI 70 to 73.4, 16.6 to 22.9, p<0.001). The initiative resulted in a projected annualised cost savings of C$221 749. DISCUSSION: A significant decrease in the AST/ALT and BUN/Cr ratios can be achieved with a multimodal approach and will result in substantial healthcare savings.

Sensitivities of nasal and rectal swabs for detection of methicillin-resistant Staphylococcus aureus colonization in an active surveillance program.

All medical and high-risk surgical patients were screened for methicillin-resistant Staphylococcus aureus colonization over 3.5 years. The sensitivities of nasal and rectal swabs were 68% and 62%, respectively. Naris and open-skin-site swabs detected 467 (74%) of 627 adult carriers identified. Rectal swabs detected an additional 160 (26%) carriers.