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Reducing red blood cell folate testing: a case study in utilisation management

Mandatory enrichment of wheat flour in Canada with folic acid since 1998 has caused folate deficiency to be rare. There were 3019 red blood cell (RBC) folate tests performed during an 18-month period at London Health Sciences Centre (LHSC)/St. Joseph’s Healthcare London (SJHC) without any folate def...

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Autores principales: Ismail, Ola, Chin-Yee, Ian, Gob, Alan, Bhayana, Vipin, Rutledge, Angela
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440601/
https://www.ncbi.nlm.nih.gov/pubmed/30997421
http://dx.doi.org/10.1136/bmjoq-2018-000531
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author Ismail, Ola
Chin-Yee, Ian
Gob, Alan
Bhayana, Vipin
Rutledge, Angela
author_facet Ismail, Ola
Chin-Yee, Ian
Gob, Alan
Bhayana, Vipin
Rutledge, Angela
author_sort Ismail, Ola
collection PubMed
description Mandatory enrichment of wheat flour in Canada with folic acid since 1998 has caused folate deficiency to be rare. There were 3019 red blood cell (RBC) folate tests performed during an 18-month period at London Health Sciences Centre (LHSC)/St. Joseph’s Healthcare London (SJHC) without any folate deficiency detected. We implemented a quality improvement initiative to reduce RBC folate testing at LHSC/SJHC. We began with a retrospective review of RBC folate tests performed during the previous 18 months. We identified physicians who had ordered more than five tests during this period and sent them an educational email to inform them of our intentions and solicit their input. We then discontinued RBC folate testing in-house and a pop-up window was introduced to the computerised physician order entry system stating that biochemist approval would be needed before samples would be sent out for testing. During the audited 18-month period, the average monthly test volume was 168 (SD 20). The three departments ordering the most RBC folate testing were nephrology (15%), haematology (7%) and oncology (7%). Physician feedback was supportive of the change, and during the 2 months after targeted email correspondence, the average monthly test volume decreased 24% (p<0.01) to 128 (SD 1). On discontinuation of the test in-house and implementation of the pop-up, the average monthly test volume decreased another 74% (p<0.01) to 3 (SD 2). In the 10 months following discontinuation of the test on-site, there were only 39 RBC folate tests performed with no deficiency detected. This initiative significantly reduced unnecessary RBC folate orders. The change in ordering on email contact suggests that physician education was an important factor reducing overutilisation. However, the most significant decrease came from restricting the test so that only orders approved by a biochemist would be performed.
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spelling pubmed-64406012019-04-17 Reducing red blood cell folate testing: a case study in utilisation management Ismail, Ola Chin-Yee, Ian Gob, Alan Bhayana, Vipin Rutledge, Angela BMJ Open Qual BMJ Quality Improvement report Mandatory enrichment of wheat flour in Canada with folic acid since 1998 has caused folate deficiency to be rare. There were 3019 red blood cell (RBC) folate tests performed during an 18-month period at London Health Sciences Centre (LHSC)/St. Joseph’s Healthcare London (SJHC) without any folate deficiency detected. We implemented a quality improvement initiative to reduce RBC folate testing at LHSC/SJHC. We began with a retrospective review of RBC folate tests performed during the previous 18 months. We identified physicians who had ordered more than five tests during this period and sent them an educational email to inform them of our intentions and solicit their input. We then discontinued RBC folate testing in-house and a pop-up window was introduced to the computerised physician order entry system stating that biochemist approval would be needed before samples would be sent out for testing. During the audited 18-month period, the average monthly test volume was 168 (SD 20). The three departments ordering the most RBC folate testing were nephrology (15%), haematology (7%) and oncology (7%). Physician feedback was supportive of the change, and during the 2 months after targeted email correspondence, the average monthly test volume decreased 24% (p<0.01) to 128 (SD 1). On discontinuation of the test in-house and implementation of the pop-up, the average monthly test volume decreased another 74% (p<0.01) to 3 (SD 2). In the 10 months following discontinuation of the test on-site, there were only 39 RBC folate tests performed with no deficiency detected. This initiative significantly reduced unnecessary RBC folate orders. The change in ordering on email contact suggests that physician education was an important factor reducing overutilisation. However, the most significant decrease came from restricting the test so that only orders approved by a biochemist would be performed. BMJ Publishing Group 2019-03-07 /pmc/articles/PMC6440601/ /pubmed/30997421 http://dx.doi.org/10.1136/bmjoq-2018-000531 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle BMJ Quality Improvement report
Ismail, Ola
Chin-Yee, Ian
Gob, Alan
Bhayana, Vipin
Rutledge, Angela
Reducing red blood cell folate testing: a case study in utilisation management
title Reducing red blood cell folate testing: a case study in utilisation management
title_full Reducing red blood cell folate testing: a case study in utilisation management
title_fullStr Reducing red blood cell folate testing: a case study in utilisation management
title_full_unstemmed Reducing red blood cell folate testing: a case study in utilisation management
title_short Reducing red blood cell folate testing: a case study in utilisation management
title_sort reducing red blood cell folate testing: a case study in utilisation management
topic BMJ Quality Improvement report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440601/
https://www.ncbi.nlm.nih.gov/pubmed/30997421
http://dx.doi.org/10.1136/bmjoq-2018-000531
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