What the Diff? (Cost Analysis Project)

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Presentation transcript:

What the Diff? (Cost Analysis Project) Richard jin Pgy-2 2/23/15

Background In general, when patients are admitted to the hospital, “basic labs” that include a basic metabolic panel and complete blood count (CBC) are ordered to obtain a baseline. If there is concern for infection, oftentimes a differential is added to the complete blood count in order to help guide treatment. The underlying issue pertains to unnecessary CBCs for hemodynamically stable patients, and differentials added to the CBCs in patients without infection.

Plan Define the requirements for obtaining a CBC and CBC with differential. Identify the cost of a CBC and CBC with differential. Monitor the ordering of CBC and CBC with differential of a ward team for one week. Ascertain the number of excessive orders and calculate the cost associated with them.

Complete Blood Count Indications Contraindications On admission New signs or symptoms of anemia New signs or symptoms of infection Gastrointestinal bleed Thrombocytopenia Contraindications Patient with none of the above criteria Daily monitoring in a hemodynamically stable patient

Complete Blood Count with Differential Indications On admission New signs or symptoms of infection Contraindications None of the criteria mentioned above Daily differentials added on a pt with either no infection or improving infection

Cost Complete Blood Count $54 Complete Blood Count with Differential $65

Results Day 1 Day 4 Day 7 Day 2 Day 5 Day 3 Day 6 Total CBCs: 3 Total CBCs: 3 Total CBCs: 1 Unnecessary CBCs: 0 Unnecessary CBCs: 0 Unnecessary CBCs: 0 Total CBC with diff: 11 Total CBC with diff: 4 Total CBC with diff: 2 Unnecessary CBC with diff: 7 Unnecessary CBC with diff: 2 Unnecessary CBC with diff: 1 Day 2 Day 5 Total CBCs: 7 Total CBCs: 2 Unnecessary CBCs: 4 Unnecessary CBCs: 0 Total CBC with diff: 5 Total CBC with diff: 3 Unnecessary CBC with diff: 2 Unnecessary CBC with diff: 1 Day 3 Day 6 Total CBCs: 6 Total CBCs: 1 Total CBC with diff: 4 Total CBC with diff: 2

% Indicated Tests per Hospital Day % Indicated CBC % Indicated CBC w/ Diff Hospital Day Hospital Day

Combined excessive costs Dollars USD Hospital Day

Projected Costs 6 Teams Dollars USD 1 week 1 year

Conclusions Excess cost of 1 team over 7 days: ~$1472 Average time to switch from CBC w/ diff CBC: 2.7 days Costs are substantially higher earlier in the hospitalization