An Ontario-Wide Survey of Perceptions and Practices Related to Routine Blood Test Ordering in the ICU
CCCF ePoster library. Rahman O. Nov 8, 2018; 233339
Dr. Omair Rahman
Dr. Omair Rahman
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Abstract
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Introduction

Routine blood testing, pre-ordered in advance, is common in the intensive care unit (ICU), and often occurs without considering the pretest probability of finding an abnormality. This practice may increase the risk of iatrogenic anemia, need for blood transfusion, false positive findings, unnecessary investigations, and cost to the healthcare system. The purpose of this survey was to understand practices and attitudes around routine blood test ordering among Ontario ICU physicians.



Methods

We identified potential respondents through personal networks and the critical care leads in each Ontario Local Health Integration Network. The target sample was one intensivist from each Level 3 ICU in Ontario (n = 55). After item generation and piloting, the final survey consisted of 15 questions across 3 domains, plus 11 demographic questions. The survey was administered electronically over a 7 month period. Responses were summarized as descriptive statistics.



Results

The 41 respondents (75% of Ontario ICUs represented) had an average 12 (SD = 7) years of clinical experience. When asked how often unnecessary blood tests are ordered, 73% responded “sometimes”, and 22% responded “almost always.' Twenty one percent stated that complete blood count should be pre-ordered daily, and 24% stated that electrolytes and creatinine should be pre-ordered daily. Most (>80%) did not favour daily testing of liver function, venous blood gas, lactate, coagulation tests, and serum troponin levels. Only 30% of respondents stated that pre-ordered routine blood testing frequently changes patient management. The 3 most common factors perceived to influence routine blood testing were physician habits, institutional tradition, and nursing preferences.



Conclusion

Most of our respondents believe blood tests are at least sometimes ordered unnecessarily. The most frequently cited determinant of routine blood testing was physician preference. We plan to disseminate this survey to intensivists across Canada. The results of this survey warrant comparison to a prospective audit of actual practice before developing any specific recommendations.

 


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