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Reducing Phlebotomy Utilization With Education and Changes to Computerized Provider Order Entry

Breen, Christopher; Maguire, Kevin; Bansal, Amit; Russin, Stanley; West, Sara; Dayal, Anju; Berger, Andrea; Olson, Jordan; Hohmuth, Benjamin

The Journal for Healthcare Quality (JHQ): May/June 2019 - Volume 41 - Issue 3 - p 154–159
doi: 10.1097/JHQ.0000000000000150
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Introduction: Daily phlebotomy is often a standard procedure in hospitalized patients. Recently, this practice has begun receiving attention as a potential target for efforts focused on eliminating overuse. Several organizations have published their efforts in this arena. Interventions have included education, feedback, and changes to computerized provider order entry (CPOE) but have yielded mixed results.

Methods: A quality improvement initiative to reduce the utilization of daily phlebotomy was conducted at a 505-bed Academic Medical Center. This project involved a combination of educational interventions and changes to CPOE. The primary end point evaluated was the daily performance of complete blood counts (CBCs) and basic metabolic profiles (BMPs) on medical and surgery units relative to the corresponding hospital census.

Results: Over the course of this project from August 1, 2013, to September 23, 2016, there was a 15.2% reduction in CBCs (p < .001 for linear trend) and 13.1% reduction in BMPs.

Discussion: Our results suggest that layering multimodal interventions that involve both “hard-wired” changes to CPOE and education and performance feedback can result in decreased utilization of phlebotomy.

For more information on this article, contact Benjamin Hohmuth at bahohmuth@geisinger.edu.

The authors declare no conflicts of interest.

The Institutional Review Board approval was waived, as no patient identifiers were collected.

© 2019 National Association for Healthcare Quality
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