Submitted by Dr Michael Chen, Jacquie Gregory and Sarah Porter, on behalf of the Choosing Wisely at Island Health Oversight Committee
Thanks to Island Health’s order set committee and our organizational participation and commitment to Using Labs Wisely we have focused on unbundling of lab tests, leading to improved ordering practices. Bundled tests, once common, are now recognized as a driver of over-testing and are no longer best practice.
Since CPOE activation at CDH, we have seen a reduction in ED lab test volumes for potentially unnecessary tests that are areas of focus for Using Labs Wisely, including coagulation tests, urea, and AST.
Focusing on just one of the tests, reducing the bundling of ALT and AST through CPOE, the overall AST testing dropped by 91% in the ED at CDH. Before CPOE, the ED averaged 495 AST tests per month (based on a 5-month pre-CPOE period), which dropped to just 45 tests per month post-activation. In contrast ALT testing increased by just 2% during the same period.
Using a tool from the Canadian Society for Medical Laboratory Science (CSMLS), we have been able to estimate the impact of this reduction in AST across the triple bottom line: patient impacts, environmental waste, and cost savings. Please note these figures are estimates.
In one year, the impacts of unbundling AST and ALT to reduce inappropriate AST testing at CDH emergency is equal to:
- ~31 litres of blood saved (the equivalent of donating blood 70 times)
- ~1,178kg of CO2 which translates to:
- 95,237 smartphones charged
- Driving 6,592km in a gas-powered car – this is equal to driving from Victoria to Winnipeg and back, twice!
- 1,309 pounds of coal burned
- 100 trash bags of waste recycled instead of being sent to the landfill
- Financial savings of:
- ~86 hours of lab technologist time
- ~$1,047 in lab supplies
- ~$315 in equipment costs
Thank you to everyone who chooses wisely for patients, for the population, and for the planet. Every contribution brings value.
Site-based data for our three Using Labs Wisley areas of focus is displayed on the Choosing Wisley at Island Health Interactive Report. Want to learn more, see the Using Labs Wisley at Island Health website for more information and educational materials.