• Natalie M Pageler, Deborah Franzon, Christopher A Longhurst, Matthew Wood, Andrew Y Shin, Eloa S Adams, Eric Widen, and David N Cornfield.
• Center for Excellence in Pulmonary Biology Divisions of Pulmonary, Asthma and Critical Care Medicine, Stanford, CA, USA. npageler@stanford.edu
• Pediatr Crit Care Me. 2013 May 1;14(4):413-9.

ObjectivesTo test the hypothesis that limits on repeating laboratory studies within computerized provider order entry decrease laboratory utilization.DesignCohort study with historical controls.SettingA 20-bed PICU in a freestanding, quaternary care, academic children's hospital.PatientsThis study included all patients admitted to the pediatric ICU between January 1, 2008, and December 31, 2009. A total of 818 discharges were evaluated prior to the intervention (January 1, 2008, through December 31, 2008) and 1,021 patient discharges were evaluated postintervention (January 1, 2009, through December 31, 2009).InterventionA computerized provider order entry rule limited the ability to schedule repeating complete blood cell counts, chemistry, and coagulation studies to a 24-hour interval in the future. The time limit was designed to ensure daily evaluation of the utility of each test.Measurements And Main ResultsInitial analysis with t tests showed significant decreases in tests per patient day in the postintervention period (complete blood cell counts: 1.5 ± 0.1 to 1.0 ± 0.1; chemistry: 10.6 ± 0.9 to 6.9 ± 0.6; coagulation: 3.3 ± 0.4 to 1.7 ± 0.2; p < 0.01, all variables vs. preintervention period). Even after incorporating a trend toward decreasing laboratory utilization in the preintervention period into our regression analysis, the intervention decreased complete blood cell counts (p = 0.007), chemistry (p = 0.049), and coagulation (p = 0.001) tests per patient day.ConclusionsLimits on laboratory orders within the context of computerized provider order entry decreased laboratory utilization without adverse affects on mortality or length of stay. Broader application of this strategy might decrease costs, the incidence of iatrogenic anemia, and catheter-associated bloodstream infections.

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