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How Tos

Toolkit: Pause the Draws

Repetitive, “routine” blood tests are associated with hospital acquired and/or worsening anemia, which is in turn associated with an increased risk of dying. Choosing Wisely Canada recommends against repetitive testing in hospitalized patients. St. Michael’s Hospital, in Toronto, documented high rates of repetitive routine blood testing and confirmed an association with worsening anemia.A goal was set to reduce repetitive routine blood tests across the hospital by 15%. The change strategy involved increasing awareness of local repetitive routine blood test rates, educating clinicians around the harms of repetitive routine blood tests, and revising order sets to remove unnecessary tests and open-ended routine blood test orders.

Prior to the intervention, the average volume of blood collected for routine blood tests per patient-day-admitted was 7.27, 9.03 and 12.07 mL/inpatient-day on the General Internal Medicine (GIM), Hematology/Oncology (Hem/Onc), and cardiovascular/ vascular surgery (CVS/PVS) services, respectively.  Following an education and awareness effort, these rates decreased to 6.10, 8.19 and 11.43 mL/inpatient-day, respectively. After order set changes were introduced, the rates decreased further to 5.30, 6.98 and 10.00mL/inpatient-day, representing total decreases of 27%, 23% and 17% respectively from the baseline period. No significant change in balance measures (length of stay and proportion of tests sent stat) was observed.

The Pause the Draws toolkit contains the key ingredients of their approach.

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