In:
Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 30, No. 34_suppl ( 2012-12-01), p. 185-185
Abstract:
185 Background: Health care institutions are identifying strategies to reduce unnecessary testing, employ better utilization of resources, and decrease risk. At Dana-Farber Cancer Institute (DFCI), patients admitted for autologous SCT have standard testing, including CXR, completed within 42 days of hospital admission. Despite previous work-up, routine CXR is often ordered on admission. We questioned if this repeat CXR was clinically necessary. A retrospective review from 2010 showed that 69 of 130 (53%) asymptomatic SCT patients had CXR obtained on the day of admission. Two patients had findings of possible atelectasis vs. infiltrate on admission CXR. No further work up or antibiotics were initiated. After count recovery, one of the two patients had a chest CT for evaluation of fevers, showing only atelectasis. Based on these results, we aimed to reduce admission CXR without clinical indication to less than 5% by July 1, 2012. Methods: A multidisciplinary group was formed to map existing processes leading to admission CXR. Areas where previous standard testing were not readily available and areas of redundancy were identified. Changes to the EMR allowing easier access to pre-transplant results were made and a written and oral education program for PAs and nocturnists was created. Study Population: All elective patients admitted to the bone marrow transplant PA service (BMT-PA) for autologous SCT for multiple myeloma or lymphoma between 11/1/11-5/30/12. Results: The intervention (changing the EMR and establishing an education program) resulted in a reduction of admission CXR in asymptomatic patients from 53.3% to 5.5% (target 5.0%). During the study period, 144 patients were admitted to the BMT-PA service. Of those, 8 had CXR without indication. All CXR were ordered by Nocturnists, two prior to the intervention and six in the last four weeks of the observation period. Conclusions: The reduction of unnecessary CXR in asymptomatic SCT patients has had a considerable reduction in overall costs, nearly $58,000 to date, as well as reduced delays in initiating chemotherapy, radiation exposure, overall resource utilization, and patient inconvenience. Through this simple intervention, this reduction was easily obtained.
Type of Medium:
Online Resource
ISSN:
0732-183X
,
1527-7755
DOI:
10.1200/jco.2012.30.34_suppl.185
Language:
English
Publisher:
American Society of Clinical Oncology (ASCO)
Publication Date:
2012
detail.hit.zdb_id:
2005181-5
