scholarly journals Duplicate Type and Screen Testing: Waste in the Clinical Laboratory

2017 ◽  
Vol 142 (3) ◽  
pp. 358-363
Author(s):  
Margaret L. Compton ◽  
Penny C. Szklarski ◽  
Garrett S. Booth
Keyword(s):  
Clinical Laboratory ◽  
Care Center ◽  
Tertiary Care ◽  
The United States ◽  
Transfusion Medicine ◽  
Laboratory Cost ◽  
System A ◽  
Medicine Service ◽  
Additional Education ◽  
Clinical Laboratory Testing

Context.— In the United States, approximately $65 billion dollars is spent per year on clinical laboratory testing, of which 20% to 30% of all testing is deemed inappropriate. There have been multiple studies in the field of transfusion medicine regarding evidence-based transfusion practices, but limited data exist regarding inappropriate pretransfusion testing and its financial and clinical implications. Objective.— To assess duplicative testing practices in the transfusion medicine service. Design.— A 24-month retrospective review was performed at a 1025-bed tertiary care center, identifying all duplicate type and screen (TS) tests performed within 72 hours of the previous TS. Duplicative testing was classified as appropriate or inappropriate by predetermined criteria. The level of underordering was analyzed through a query of the electronic event reporting system. A cost analysis was performed to determine the financial impact of inappropriate duplicative TS. Results.— The mean rate of inappropriate, duplicative TS orders was 4.13% (standard deviation ± 4.09%). Rates of inappropriate ordering ranged from 0.01% to 15.5% depending on the clinical service and did not correlate with volume of tests ordered. There were 8 reported cases of delayed blood delivery due to lack of a valid TS during the study period, demonstrating that underordering is also a harmful practice. The laboratory cost of inappropriate testing for the study period was $80,434, and phlebotomy costs were $45,469. Conclusions.— Our study demonstrates that inappropriate TS ordering is costly, both financially and clinically. By evaluating the percentage of inappropriate TS tests by clinical services, we have identified services that may benefit from additional education and technologic intervention.

scholarly journals Impact of Rapid PCR Influenza Testing on the Rate of Inpatient Admissions During Influenza Season at a Tertiary-Care Center

2020 ◽  
Vol 41 (S1) ◽  
pp. s263-s264
Author(s):  
Jordan Polistico ◽  
Avnish Sandhu ◽  
Teena Chopra ◽  
Erin Goldman ◽  
Jennifer LeRose ◽  
...  
Keyword(s):  
Influenza Season ◽  
Care Center ◽  
Tertiary Care ◽  
The United States ◽  
Turnaround Time ◽  
Care Hospital ◽  
Tertiary Care Center ◽  
Pediatric Hospital ◽  
Rapid Pcr ◽  
The Impact

Background: Influenza causes a high burden of disease in the United States, with an estimate of 960,000 hospitalizations in the 2017–2018 flu season. Traditional flu diagnostic polymerase chain reaction (PCR) tests have a longer (24 hours or more) turnaround time that may lead to an increase in unnecessary inpatient admissions during peak influenza season. A new point-of-care rapid PCR assays, Xpert Flu, is an FDA-approved PCR test that has a significant decrease in turnaround time (2 hours). The present study sought to understand the impact of implementing a new Xpert Flu test on the rate of inpatient admissions. Methods: A retrospective study was conducted to compare rates of inpatient admissions in patients tested with traditional flu PCR during the 2017–2018 flu season and the rapid flu PCR during the 2018–2019 flu season in a tertiary-care center in greater Detroit area. The center has 1 pediatric hospital (hospital A) and 3 adult hospitals (hospital B, C, D). Patients with influenza-like illness who presented to all 4 hospitals during 2 consecutive influenza seasons were analyzed. Results: In total, 20,923 patients were tested with either the rapid flu PCR or the traditional flu PCR. Among these, 14,124 patients (67.2%) were discharged from the emergency department and 6,844 (32.7%) were admitted. There was a significant decrease in inpatient admissions in the traditional flu PCR group compared to the rapid flu PCR group across all hospitals (49.56% vs 26.6% respectively; P < .001). As expected, a significant proportion of influenza testing was performed in the pediatric hospital, 10,513 (50.2%). A greater reduction (30% decrease in the rapid flu PCR group compared to the traditional flu PCR group) was observed in inpatient admissions in the pediatric hospital (Table 1) Conclusions: Rapid molecular influenza testing can significantly decrease inpatient admissions in a busy tertiary-care hospital, which can indirectly lead to improved patient quality with easy bed availability and less time spent in a private room with droplet precautions. Last but not the least, this testing method can certainly lead to lower healthcare costs.Funding: NoneDisclosures: None

scholarly journals Use of the Fluoride Varnish Billing Code in a Tertiary Care Center Setting

2020 ◽  
Vol 11 ◽  
pp. 215013272091373
Author(s):  
Peter Kim ◽  
Jeanette M. Daly ◽  
Sharon Berkowitz ◽  
Barcey T. Levy
Keyword(s):  
Teaching Hospital ◽  
Task Force ◽  
Care Center ◽  
Tertiary Care ◽  
The United States ◽  
Fluoride Varnish ◽  
Successful Implementation ◽  
Clinical Notes ◽  
Tertiary Teaching ◽  
Tertiary Teaching Hospital

Introduction: Dental caries is the most common chronic disease in children from birth through 5 years of age. Application of fluoride varnish (FV) is recommended for children younger than 6 years every 3 to 6 months by the United States Preventive Services Task Force. The purposes of this study were to (1) assess use and reimbursement of Current Dental Terminology (CDT) D1206 and Current Procedural Terminology (CPT) 99188 codes, which are the billing codes for FV application; (2) determine when and by whom each FV code was used; and (3) summarize the associated clinical notes. Methods: Using the electronic medical record data warehouse from a single tertiary teaching hospital and its affiliated primary care clinics, the dates of service, departments, provider names, and patient identifiers associated with codes CDT D1206 and CPT 99188 were collected. The content of clinical notes was reviewed and summarized. The study period was from May 1, 2009 through May 17, 2019. Results: During the 10-year time period, CDT D1206 was used 5 times and CPT 99188 was used 35 times. FV was applied exclusively during well-child visits. Only pediatricians, and no family physicians, applied FV in this setting. Discussion: A single pediatrician championing for FV application increased both the completion of procedure and the appropriate billing in 2019. Conclusion: FV application has been likely underutilized in this Midwestern tertiary teaching hospital and its affiliated clinics. For both family medicine and pediatric offices, an advocate for caries prevention is likely needed for successful implementation of FV application at well-child visits.

Clinical and Electroencephalographic Correlates in Pediatric Cardiac Arrest: Experience at a Tertiary Care Center

2018 ◽  
Vol 49 (05) ◽  
pp. 324-329 ◽  
Author(s):  
Jun Park ◽  
Garrett Brooks
Keyword(s):  
Cardiac Arrest ◽  
Clinical Laboratory ◽  
Cardiopulmonary Arrest ◽  
Pediatric Population ◽  
Care Center ◽  
Tertiary Care ◽  
Cerebral Performance Category ◽  
Neurologic Outcome ◽  
Background Suppression ◽  
Poor Outcome

AbstractPediatric cardiac arrest is a significant cause of death and neurologic disability; however, there is a paucity of literature specifically evaluating the utility of prognostic factors in the pediatric population. This retrospective chart review examines clinical, laboratory, and electroencephalographic (EEG) data in children following cardiopulmonary arrest to better characterize findings that may inform prognosis. Pre-arrest clinical characteristics, resuscitation details, and post-arrest hospital course variables were analyzed and neurologic outcome was determined using the Pediatric Cerebral Performance Category scale. Forty-one patients were identified who had cardiac arrest from March, 2011 to January, 2015. Duration of cardiopulmonary resuscitation (p = 0.013), out-of-hospital arrest (p = 0.005), arterial pH (0.014), arterial lactate (0.004), lack of pupil reactivity to light (p < 0.001), absent motor response to noxious stimuli (p < 0.001), and absent brainstem reflexes (p < 0.001) were all predictors of poor neurologic outcome. EEG background suppression (p = 0.005) was associated with poor outcome. Nine patients had electrographically recorded seizures, which began up to 1 week following cardiac arrest. Two patients (4.9%) experienced post-anoxic myoclonic status epilepticus and both had a poor outcome.

scholarly journals Yield of Muscle Biopsy in Patients with Findings of Myopathy on Electrodiagnostic Testing

2019 ◽  
Vol 10 (03) ◽  
pp. 489-493 ◽  
Author(s):  
Sarah Hasan Siddiqui ◽  
Raheel Ahmed ◽  
Safia Awan ◽  
Ambreen Zain ◽  
Sara Khan
Keyword(s):  
Muscle Biopsy ◽  
Clinical Laboratory ◽  
Diagnostic Yield ◽  
Care Center ◽  
Tertiary Care ◽  
Neuromuscular Diseases ◽  
Genetic Tests ◽  
Factors Affecting ◽  
Electrodiagnostic Testing ◽  
Hereditary Myopathy

Abstract Background The evaluation of neuromuscular diseases includes detailed clinical assessment, blood testing, electrodiagnostic studies (EDS), biopsy, and genetic tests. EDS alone cannot provide a specific diagnosis. Further testing in the form of genetic tests or muscle biopsy (MB) is required. Objective The objective of the study is to evaluate the yield of MB in patients with findings of myopathy on electrodiagnostic testing and assess the factors affecting an abnormal biopsy outcome. Methods Electromyography (EMG)/nerve conduction studies (NCS) performed for suspected myopathy over 5 years from 2011 to 2016, at the neurophysiology department of a tertiary care center in Pakistan, were reviewed. Based on inclusion criteria, records of 58 patients were retrospectively reviewed. Results After an EMG/NCS diagnosis of myopathy, the frequency of MB testing was only 10.1%. The median age of patients was 26.5 years. The clinically suspected diagnosis was categorized into hereditary myopathy (n = 15, 25.9%) and acquired myopathy (n = 18, 31%). The positive predictive value of EMG is 77.2%. Twenty-eight (48.2%) patients had abnormal MB whereas 20 (34.4%) revealed normal findings. Factors significantly influencing an abnormal outcome of biopsy included moderate-to-severe elevation of creatine kinase (>2,000 U/L),presence of denervation changes, and severe myopathy on EMG. Conclusion Even though the overall yield of MB testing may not be very high in our setting due to the unavailability of special techniques and expertise, certain factors can help to improve the diagnostic yield. Clinicians should encourage MB testing, especially in cases with strong clinical, laboratory and electrodiagnostic suspicion, and absence of genetic testing for suspected myopathy.

scholarly journals Cholelithiasis in Cystic Fibrosis Patients in a Tertiary Care Center in Saudi Arabia

2020 ◽  
Vol 2 (2) ◽  
pp. 37-43
Author(s):  
Banjar H ◽  
Al-Ghuneim L ◽  
Al-Shammari A ◽  
Al-Mulhim FA ◽  
Al-Eid M ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Clinical Laboratory ◽  
Care Center ◽  
Pancreatic Insufficiency ◽  
Tertiary Care ◽  
Age Groups ◽  
Retrospective Chart Review ◽  
Abdominal Ultrasound ◽  
Abdominal Sonography

Introduction: Cholelithiasis has been reported in 12%-24% of Cystic Fibrosis (CF) patients, and is usually made up of cholesterol gallstones. These abnormalities are frequently asymptomatic and can include intra and extrahepatic ducts, gallbladder thickening and contraction, micro gallbladders, and cholelithiasis. Abdominal sonography is routinely used in order to detect these abnormalities. Objectives: To obtain the prevalence of gall stones (Cholelithasis) in CF patients and its relation to other clinical, laboratory, radiological, and genetic data. Methodology: A retrospective chart review as part of the CF registry data from the period 1st January 1984 – 1st June 2018. All confirmed CF the patients of all age groups that have US studies done were included in the study. Patients with positive gallstones or sludge were evaluated and discussed. Results: A total of 391 confirmed CF patients were involved. Out of them, 252 patients had an abdominal ultrasound, 7 patients (3%) had gallstones on the abdominal US, 8 patients (3%) were revealed to have sludge and 237 patients (94%) had normal gallbladders. Pancreatitis was found in 4 patients (2%). 191 patients (76%) had pancreatic insufficiency.77 patients had follow up abdominal ultrasounds and 5 patients (7%) were found to have persistent gallstones, 4 patients (5%) had persistent sludge and 68 patients (88%) remained negative for gallstones. 2 patients required cholecystectomy. Conclusion: Cholelithiasis is a common complication of CF disease; its incidence is more than the general population. Thus, we recommend that every CF patient get an ultrasonography study as part of liver disease screening to rule out any Gallbladder pathology.

scholarly journals Hospitalized COVID-19 Patients treated with Convalescent Plasma in a Mid-size City in the Midwest

2020 ◽  
Author(s):  
William Hartman ◽  
Aaron S Hess ◽  
Joseph P Connor
Keyword(s):  
Mechanical Ventilation ◽  
Care Center ◽  
Severe Disease ◽  
Tertiary Care ◽  
The United States ◽  
Severe Illness ◽  
Care Needs ◽  
Course Of Disease ◽  
Effective Option ◽  
Life Threatening

AbstractBackgroundSARS-CoV-2 and its associated disease, COVID-19, has infected over seven million people world-wide, including two million people in the United States. While many people recover from the virus uneventfully, a subset of patients will require hospital admission, some with intensive care needs including intubation, and mechanical ventilation. To date there is no cure and no vaccine is available. Passive immunotherapy by the transfusion of convalescent plasma donated by COVID-19 recovered patients might be an effective option to combat the virus, especially if used early in the course of disease. Here we report our experience of using convalescent plasma at a tertiary care center in a mid-size, midwestern city that did not experience an overwhelming patient surge.MethodsHospitalized COVID-19 patients categorized as having Severe or Life-Threatening disease according to the Mayo Clinic Emergency Access Protocol were screened, consented, and treated with convalescent plasma collected from local donors recovered from COVID-19 infection. Clinical data and outcomes were collected retrospectively.Results31 patients were treated, 16 severe patients and 15 life-threatened patients. Overall mortality was 27% (4/31) but only patients with life-threatening disease died. 94% of transfused patients with severe disease avoided escalation to ICU care and mechanical ventilation. 67% of patients with life-threatening disease were able to be extubated. Most transfused patients had a rapid decrease in their respiratory support requirements on or about day 7 following convalescent plasma transfusion.ConclusionOur results demonstrate that convalescent plasma is associated with reducing ventilatory requirements in patients with both severe and life-threatening disease, but appears to be most beneficial when administered early in the course of disease when patients meet the criteria for severe illness.

A Single-Center Experience With Percutaneous Interventional Management of Refractory Chylous Ascites

2020 ◽  
pp. 084653712092942
Author(s):  
Elizabeth Tai ◽  
Adam Min ◽  
Dheeraj K. Rajan
Keyword(s):  
Conservative Management ◽  
Care Center ◽  
Tertiary Care ◽  
Management Strategies ◽  
Chylous Ascites ◽  
The United States ◽  
Single Center Experience ◽  
Interventional Management ◽  
Invasive Method ◽  
Glue Embolization

Purpose: Management of chylous ascites is poorly understood with no management guidelines. We retrospectively reviewed patients treated for chylous ascites at our institution to evaluate efficacy and safety of lipiodol lymphangiography and embolization. Materials and Methods: Seven patients underwent percutaneous interventional management of chylous ascites (average age 52.5 years, 3 female, 6 post-surgical, 1 pancreatitis) from 2012. All patients underwent lipiodol inguinal lymph node injection. Adjunctive glue embolization was performed if a leak was identified. Data were collected on the cause of chylous ascites, conservative management strategies, procedural details, and success. Results: All patients had chylous ascites refractory to conservative management. Preprocedure lymphoscintigraphy identified a retroperitoneal leak in 6 patients. Seven patients underwent 12 lymphangiogram procedures; 8 were performed at our institution. Lymphangiography identified a leak in 5 patients (71%). Success was achieved in 2 patients (28%) treated at our institution after glue embolization following cannulation of the leaking lymphatic channels and 1 patient (14%) after lymphangiography alone for an overall success rate of 43% (3/7). Two patients (29%) were successfully treated after one procedure. Two patients (29%) unsuccessfully treated at our institution were referred to a specialized center in the United States. No 30 day post procedural complications. Conclusions: In our experience, lymphangiography and embolization was a safe, relatively effective and minimally invasive method for treating medically refractory chylous ascites. Complex cases required referral to a specialized institution with resources unavailable at our tertiary care center.

Outcomes of Monochorionic, Diamniotic Twin Pregnancies with Prenatally Diagnosed Intertwin Weight Discordance

2020 ◽  
Author(s):  
Nasim C. Sobhani ◽  
Teresa N. Sparks ◽  
Kristen A. Gosnell ◽  
Larry Rand ◽  
Juan M. Gonzalez ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pregnancy Outcome ◽  
Care Center ◽  
Tertiary Care ◽  
Subsequent Development ◽  
The United States ◽  
Secondary Outcome ◽  
Fetal Ultrasound ◽  
Factors Associated ◽  
Twin Pregnancies

Objective Monochorionic, diamniotic (MCDA) twin pairs are predisposed to various pregnancy complications due to the unique placental angioarchitecture of monochorionicity. Few studies have evaluated the outcomes of weight-discordant MCDA pairs without selective fetal growth restriction (SFGR) or the risk factors for development of SFGR. This study aims to describe the natural history of expectant, noninvasive management of weight-discordant MCDA twins and to evaluate risk factors associated with progression to SFGR. Study Design This was a retrospective cohort study at a single, tertiary care center in the United States. All MCDA twins with isolated intertwin weight discordance (ITWD) ≥ 20% diagnosed before 26 weeks' gestational age (GA) were included. The primary outcome of descriptive analyses was overall pregnancy outcome, incorporating both survival to delivery and GA at delivery, as defined by the North American Fetal Therapy Network. The secondary outcome was SFGR in one twin (defined as estimated fetal weight < 10% for GA) and factors associated with this progression. Only those with fetal ultrasound (US) within 4 weeks of delivery were included in this secondary analysis. Results Among 73 MCDA pairs with ITWD, 73% had a good pregnancy outcome, with dual live delivery at a median GA of 33 weeks. Among the 34 pairs with adequate US follow-up, 56% developed SFGR. There were no differences in GA at delivery or discordance at birth between those who did and those who did not develop SFGR. There was a nonsignificant association between increasing ITWD at diagnosis and subsequent development of SFGR. Conclusion Expectant, noninvasive management can be considered in MCDA twin pregnancies with ITWD ≥ 20% diagnosed before 26 weeks. This approach is associated with a good pregnancy outcome in the majority of cases, even after the development of SFGR in the smaller twin. Key Points

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