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中华重症医学电子杂志 ›› 2024, Vol. 10 ›› Issue (04) : 329 -333. doi: 10.3877/cma.j.issn.2096-1537.2024.04.003

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关注ICU 患者接受的非必要血液检测
姚庆春1, 魏光晨2, 孟玫3,()   
  1. 1.200233 上海,上海嘉会国际医院重症医学科
    2.271100济南,济南市人民医院 山东第一医科大学附属人民医院重症医学临床研究中心
    3.200025 上海,上海交通大学医学院附属瑞金医院重症医学科
  • 收稿日期:2024-02-06 出版日期:2024-11-28
  • 通信作者: 孟玫
  • 基金资助:
    国家自然科学基金资助项目(82272234,82372203)济南市医疗卫生行业高层次人才专项经费资助

Pay attention to non-essential blood tests received by ICU patients

Qingchun Yao1, Guangchen Wei2, Mei Meng3,()   

  1. 1.Department of Critical Care Medicine, Jiahui International Hospital, Shanghai 200233, China
    2.Jinan People’s Hospital, Clinical Research Center for Critical Care Medicine of People’s Hospital Affiliated Shandong First Medical University, Jinan 271100, China
    3.Department of Critical Care Medicine, Ruijin Hospital Affiliated to School of Medicine of Shanghai Jiao Tong University, Shanghai 200025, China
  • Received:2024-02-06 Published:2024-11-28
  • Corresponding author: Mei Meng
引用本文:

姚庆春, 魏光晨, 孟玫. 关注ICU 患者接受的非必要血液检测[J/OL]. 中华重症医学电子杂志, 2024, 10(04): 329-333.

Qingchun Yao, Guangchen Wei, Mei Meng. Pay attention to non-essential blood tests received by ICU patients[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2024, 10(04): 329-333.

ICU 患者通常要接受频繁的日常诊断检测用于监测隐匿性风险。然而,非针对具体临床问题而进行的、重复的、常规的、每日的非必要检测,常常伴随其中。非必要血液检测相关的采血可导致医院获得性贫血,与住院时间延长、输血需求增加和病死率增加有关。同时,非必要检测也产生了巨大的经济负担。本研究回顾了ICU 中非必要实验室检测的现状、危害以及措施,以期提高对ICU患者接受非必要血液检测的关注,并促进ICU 的高质量发展。

Patients in the ICU typically undergo frequent daily diagnostic tests to monitor hidden risks.Nevertheless, there are numerous additional repetitive, routine, and non-essential tests performed on regularly that are not specifically focused on addressing clinical concerns.Non-essential blood testing related to blood collection can lead to hospital-acquired anemia, which is associated with prolonged hospital stays,increased blood transfusion demand, and a higher mortality rate.Simultaneously, conducting non-essential testing imposes a significant economic strain.We reviewed the current situation, hazards, and measures of non-essential laboratory testing in the ICU, with the aim of increasing attention to ICU patients receiving nonessential blood testing and promoting high-quality development of the ICU.

1
Zimmerman JE, Seneff MG, Sun X, et al.Evaluating laboratory usage in the intensive care unit: patient and institutional characteristics that influence frequency of blood sampling [J].Crit Care Med, 1997, 25(5):737-748.
2
Garland A, Shaman Z, Baron J, et al.Physician-attributable differences in intensive care unit costs: a single-center study [J].Am J Respir Crit Care Med, 2006, 174(11): 1206-1210.
3
Ezzie ME, Aberegg SK, O’Brien Jr JM.Laboratory testing in the intensive care unit [J].Crit Care Clin, 2007, 23(3): 435-465.
4
Hayden SJ, Albert TJ, Watkins TR, et al.Anemia in critical illness:insights into etiology, consequences, and management [J].Am J Respir Crit Care Med, 2012, 185(10): 1049-1057.
5
Tinmouth AT, McIntyre LA, Fowler RA.Blood conservation strategies to reduce the need for red blood cell transfusion in critically ill patients[J].CMAJ, 2008, 178(1): 49-57.
6
von Ahsen N, Muller C, Serke S, et al.Important role of nondiagnostic blood loss and blunted erythropoietic response in the anemia of medical intensive care patients [J].Crit Care Med, 1999, 27(12): 2630-2639.
7
Chant C, Wilson G, Friedrich JO.Anemia, transfusion, and phlebotomy practices in critically ill patients with prolonged ICU length of stay: a cohort study [J].Crit Care, 2006, 10(5): R140.
8
Halpern NA, Bettes L, Greenstein R.Federal and nationwide intensive care units and healthcare costs: 1986-1992 [J].Crit Care Med, 1994,22(12): 2001-2007.
9
Emanuel E, Tanden N, Altman S, et al.A systemic approach to containing healthcare spending [J].N Engl J Med, 2012, 367(10): 949-954.
10
Zhi M, Ding EL, Theisen-Toupal J, et al.The landscape of inappropriate laboratory testing: a 15-year meta-analysis [J].PLoS One, 2013, 8(11):e78962.
11
Miyakis S, Karamanof G, Liontos M, et al.Factors contributing to inappropriate ordering of tests in an academic medical department and the effect of an educational feedback strategy [J].Postgrad Med J,2006, 82(974): 823-829.
12
Kleinpell RM, Farmer JC, Pastores SM.Reducing unnecessary testing in the intensive care unit by choosing wisely [J].Acute Crit Care,2018, 33(1):1-6.
13
Peixoto AA Jr, Meneses FA, Barbosa BP, et al.Laboratory routine in the ICU: a practice to be abolished? [J].Crit Care, 2013, 17(Suppl 3):P12.
14
Kumwilaisak K, Noto A, Schmidt UH, et al.Effect of laboratory testing guidelines on the utilization of tests and order entries in a surgical intensive care unit [J].Crit Care Med, 2008, 36 (11): 2993-2999.
15
Iosfina I, Merkeley H, Cessford T, et al.Implementation of an ondemand strategy for routine blood testing in ICU patients [J].Am J Respir Crit Care Med, 2013, 187: A5322.
16
Pageler NM, Franzon D, Longhurst CA, et al.Embedding time-limited laboratory orders within computerized provider order entry reduces laboratory utilization [J].Pediatr Crit Care Med, 2013, 14(4): 413-419.
17
See KC, Phua J, Mukhopadhyay A.Monitoring of extubated patients:are routine arterial blood gas measurements useful and how long should patients be monitored in the intensive care unit? [J].Anaesth Intensive Care, 2010, 38(1): 96-101.
18
Kwok J, Jones B.Unnecessary repeat requesting of tests: an audit in a government hospital immunology laboratory [J].J Clin Pathol, 2005,58(5): 457-462.
19
Sedrak MS, Patel MS, Ziemba JB, et al.Residents’ self-report on why they order perceived unnecessary inpatient laboratory tests [J].J Hosp Med, 2016, 11(12): 869-872.
20
Rothberg MB, Class J, Bishop TF, et al.The cost of defensive medicine on 3 hospital medicine services [J].JAMA Intern Med, 2014,174(11): 1867-1868.
21
Thavendiranathan P, Bagai A, Ebidia A, et al.Do blood tests cause anemia in hospitalized patients? The effect of diagnostic phlebotomy on hemoglobin and hematocrit levels [J].J Gen Intern Med, 2005,20(6): 520-524.
22
Holland J, Peralta RM, Moss RL, et al.A single-centre review of iatrogenic anaemia in adult intensive care [J].Transfus Med, 2020,30(3): 196-200.
23
Corwin HL, Parsonnet KC, Gettinger A.RBC transfusion in the ICU.Is there a reason? [J].Chest, 1995, 108(3): 767-771.
24
Flabouris A, Bishop G, Williams L, et al.Routine blood test ordering for patients in intensive care [J].Anaesth Intensive Care, 2000, 28:(5)562-565.
25
Bodley T, Kwan JL, Matelski J, et al.Test result management practices of Canadian internal medicine physicians and trainees [J].J Gen Intern Med, 2019, 34(1): 118-124.
26
Manor-Shulman O, Beyene J, Frndova H, et al.Quantifying the volume of documented clinical information in critical illness [J].J Crit Care, 2008, 23(2): 245-250.
27
Bruce CR, Fetter JE, Blumenthal-Barby JS.Cascade effects in critical care medicine: a call for practice changes [J].Am J Respir Crit Care Med, 2013, 188(12): 1384-1385.
28
Carpenter CR, Raja AS, Brown MD.Overtesting and the downstream consequences of overtreatment: implications of “preventing overdiagnosis” for emergency medicine [J].Acad Emerg Med, 2015,22(12): 1484-1492.
29
Koch CG, Li L, Sun Z, et al.Hospital-acquired anemia: prevalence,outcomes, and healthcare implications [J].J Hosp Med, 2013, 8(9):506-512.
30
Health Care Spending and the Medicare Program [M].Medicare Payment Advisory Commission (MedPAC), 2020.
31
Choosing Wisely List for Critical Care: Five Things Physicians and Patients Should Question [R].Critical Care Societies Collaborative:ABIM Foundation, 2014.
32
Kobewka DM, Ronksley PE, McKay JA, et al.Influence of educational, audit and feedback, system based, and incentive and penalty interventions to reduce laboratory test utilization: a systematic review [J].Clin Chem Lab Med, 2015, 53(2): 157-183.
33
Raad S, Elliott R, Dickerson E, et al.Reduction of laboratory utilization in the intensive care unit [J].J Intensive Care Med, 2017, 32(8): 500-507.
34
Bindraban RS, Beneden M, Kramer MHH, et al.Association of a multifaceted intervention with ordering of unnecessary laboratory tests among caregivers in internal medicine departments [J].JAMA Netw Open, 2019, 2(7): e197577.
35
Bindraban RS, Ten Berg MJ, Naaktgeboren CA, et al.Reducing test utilization in hospital settings: a narrative review [J].Ann Lab Med,2018, 38(5): 402-412.
36
Mikhaeil M, Day AG, Ilan R.Non-essential blood tests in the intensive care unit: a prospective observational study [J].Can J Anesth, 2017,64(3): 290-295.
37
Angus DC, Deutschman CS, Hall JB, et al.Choosing wisely in critical care: maximizing value in the ICU [J].Chest, 2014, 146(5): 1142-1144.
38
Henschke CI, Yankelevitz DF, Wand A, et al.Chest radiography in the ICU [J].Clin Imaging, 1997, 21(2): 90-103.
39
Rubinowitz AN, Siegel MD, Tocino I.Thoracic imaging in the ICU [J].Crit Care Clin, 2007, 23(3): 539-573.
40
Attali M, Barel Y, Somin M, et al.A cost-effective method for reducing the volume of laboratory tests in a university-associated teaching hospital [J].Mt Sinai J Med, 2006, 73(5):787-794.
41
Vidyarthi AR, Hamill T, Green AL, et al.Changing resident test ordering behavior: a multilevel intervention to decrease laboratory utilization at an academic medical center [J].Am J Med Qual, 2015,30(1): 81-87.
42
Corson AH, Fan VS, White T, et al.A multifaceted hospitalist quality improvement intervention: decreased frequency of common labs [J].J Hosp Med, 2015, 10(6): 390-395.
43
Roman BR, Yang A, Masciale J, et al.Association of attitudes regarding overuse of inpatient laboratory testing with health care provider type [J].JAMA Intern Med, 2017, 177(8): 1205-1207.
44
Sedrak MS, Myers JS, Small DS, et al.Effect of a price transparency intervention in the electronic health record on clinician ordering of inpatient laboratory tests: the PRICE randomized clinical trial [J].JAMA Intern Med, 2017, 177(7): 939-945.
45
Newman DB, Siontis KC, Chandrasekaran K, et al.Intervention to reduce inappropriate ionized calcium ordering practices: a qualityimprovement project [J].Perm J, 2015, 19(1): 49-51.
46
Lee VS, Kawamoto K, Hess R, et al.Implementation of a value-driven outcomes program to identify high variability in clinical costs and outcomes and association with reduced cost and improved quality [J].JAMA, 2016, 316(10): 1061-1072.
47
Iams W, Heck J, Kapp M, et al.A multidisciplinary housestaff-led initiative to safely reduce daily laboratory testing [J].Acad Med, 2016,91 (6): 813-820.
48
Yarbrough PM, Kukhareva PV, Horton D, et al.Multifaceted intervention including education, rounding checklist implementation,cost feedback, and financial incentives reduces inpatient laboratory costs [J].J Hosp Med, 2016, 11(5): 348-354.
49
Tawfik B, Collins JB, Fino NF, et al.House officer-driven reduction in laboratory utilization [J].South Med J, 2016, 109(1): 5-10.
50
Minerowicz C, Abel N, Hunter K, et al.Impact of weekly feedback on test ordering patterns [J].Am J Manag Care, 2015, 21(11): 763-768.
51
Salman M, Pike DC, Wu R, et al.Effectiveness and safety of a clinical decision rule to reduce repeat ionized calcium testing: a pre/post test intervention [J].Conn Med, 2016, 80(1): 5-10.
52
Silvestri MT, Bongiovanni TR, Glover JG, et al.Impact of price display on provider ordering: a systematic review [J].J Hosp Med,2016, 11(1): 65-76.
53
Sadowski BW, Lane AB, Wood SM, et al.High-value, cost-conscious care: iterative systems-based interventions to reduce unnecessary laboratory testing [J].Am J Med, 2017, 130 (9): 1112.e1-1112.e7.
54
May TA, Clancy M, Critchfield J, et al.Reducing unnecessary inpatient laboratory testing in a teaching hospital [J].Am J Clin Pathol,2006, 126(2): 200-206.
55
Calderon-Margalit R, Mor-Yosef S, Mayer M, et al.An administrative intervention to improve the utilization of laboratory tests within a university hospital [J].Int J Qual Health Care, 2005, 17(3): 243-248.
56
McDonald EG, Saleh RR, Lee TC.Mindfulness-based laboratory reduction: reducing utilization through trainee-led daily “time outs.”[J].Am J Med, 2017, 130(6): e241-e244.
57
Merkeley HL, Hemmett J, Cessford TA, et al.Multipronged strategy to reduce routine-priority blood testing in intensive care unit patients [J].J Crit Care, 2016, 31(1): 212-216.
58
Ambasta A, Ma IWY, Woo S, et al.Impact of an education and multilevel social comparison-based intervention bundle on use of routine blood tests in hospitalized patients at an academic tertiary care Hospital: a controlled pre-intervention post-intervention study [J].BMJ Qual Saf, 2020, 29(10): 1-2.
59
Solomon DH, Hashimoto H, Daltroy L, et al.Techniques to improve physicians’ use of diagnostic tests: a new conceptual framework [J].JAMA, 1998, 280(23): 2020-2027.
60
Martínez-Balzano CD, Oliveira P, O’Rourke M, et al.An educational intervention optimizes the use of arterial blood gas determinations across ICUs from different specialties: a quality-improvement study [J].Chest, 2017, 151(3): 579-585.
61
Basharat S, Born K.Using health care resources wisely after the COVID-19 pandemic: recommendations to reduce low-value care [J].Can J Health Technol, 2021, 1(5): 1-29.
62
Riessen R, Behmenburg M, Blumenstock G, et al.A simple “bloodsaving bundle” reduces diagnostic blood loss and the transfusion rate in mechanically ventilated patients [J].PLoS One, 2015, 10(9):e0138879.
63
Mukhopadhyay A, Yip HS, Prabhuswamy D, et al.The use of a blood conservation device to reduce red blood cell transfusion requirements:a before and after study [J].Crit Care, 2010, 14(1): R7.
64
Page C, Retter A, Wyncoll D.Blood conservation devices in critical care: a narrative review [J].Ann Intensive Care, 2013, 3: 14.
65
Houben PH, Winkens RA, van der Weijden T, et al.Reasons for ordering laboratory tests and relationship with frequency of abnormal results [J].Scand J Prim Health Care, 2010, 28(1): 18-23.
66
Siegal DM, Manning N, Jackson Chornenki NL, et al.Devices to reduce the volume of blood taken for laboratory testing in ICU patients: a systematic review [J].J Intensive Care Med, 2020, 35(10):1074-1079.
67
Briggs EN, Hawkins DJ, Hodges AM, et al.Small volume vacuum phlebotomy tubes: a controlled before-and-after study of a patient blood management initiative in an Australian adult intensive care unit[J].Crit Care Resusc, 2019, 21(4): 251-257.
68
Harber CR, Sosnowski KJ, Hegde RM.Highly conservative phlebotomy in adult intensive care--a prospective randomized controlled trial [J].Anaesth Intensive Care, 2006, 34(4): 434-437.
69
Siegal DM, Belley-Côté EP, Lee SF, et al.Small-volume tubes to reduce anemia and transfusion (STRATUS): a pilot study [J].Can J Anaesth, 2023, 70(11): 1797-1806.
70
Siegal DM, Belley-Côté EP, Lee SF, et al.Small-volume blood collection tubes to reduce transfusions in intensive care: the STRATUS randomized clinical trial [J].JAMA, 2023, 330(19): 1872-1881.
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