Background Recurring lab studies in the form of ABG, VBG, CBC, electrolytes, renal function panels and coagulation measurements are commonplace in PCICU. This practice pattern provides an element of safety by providing surveillance of patient’s volatile physiologies. This practice has unintended negative consequences including expense, laboratory “alarm fatigue” for providers, and increased risk of CLABSI. These consequences are intensified when recurring lab studies occur indefinitely and when lab draws are poorly synchronized so that the vascular catheter is accessed more frequently than necessary.

Methods The investigators worked with EPIC software professionals to construct a lab order set that speeds order entry, provides a comprehensive, individualized menu of lab tests most commonly ordered in the PCICU, enforces synchronization of blood draws, caps the number of days the selected labs will be drawn, and notifies the care team when slates of recurring lab tests are expiring. We wish to examine the effect of this intervention on the total number of labs drawn per patient per day, the daily cost, the number of times vascular catheters are accessed, and the number of patient resuscitations observed. Our lab order set is currently under construction by EPIC.

Results We are currently receiving via automated EPIC electronic database a daily report of the number of each type of lab test performed per patient during each 24-hour period for one month. From this data we will tabulate a) the total number of each type of lab test performed per patient per day, b) the estimated total cost and charge for all lab testing per patient per day, and c) the number of times per day that blood is drawn from a vascular catheter per patient per day.

As surrogates of potential negative consequences of lab reduction, we will monitor number of patient resuscitations that occur during the pre-intervention and post-intervention phases and number of times per patient per day that vascular catheters are accessed. We will compare these outcomes before and after implementation. Finally, to assess compliance, we will express the percentage of the average daily census who have an active laboratory order set in use with a specified expiration date.

Conclusion It is our hope that the convenience and simplicity of the PCICU order set will result in a) regular utilization by our providers, b) reduced overall lab testing, c) reduced cost and patient charges, d) fewer accessions of the indwelling vascular catheters, and e) no increase in resuscitation events in our intensive care unit.