BMP Ordering Practice Among UCI Wards Teams Prepared by: Michael Rochon-Duck UCI Internal Medicine December 17, 2012

Motivation and Background The basic metabolic panel is a “routine lab” frequently ordered by IM wards teams QUEST makes it easy to order repeating labs Each BMP costs $14

Study Design and Data Sources A cross-sectional study of patients admitted to the six UCI internal medicine wards services on December 16, 2012 For each patient, the following was recorded: Date of admission Current care team Number of BMP or CMP resulted on each day of hospital stay If patient has order for repeating labs

Analytical Methods Exploratory plots and statistics Comparison of the number of BMPs between patients with an order for repeating daily BMPs and those without

Discussion Findings of this study Limitations Longer-stay patients tend toward daily BMP, costing $14 per patient per day Teams vary in their use of repeating labs Automatically repeating BMP trends toward increasing utilization Limitations No criteria exist for appropriate usage of BMP Because BMP is so routine, justification for ordering the test is seldom documented in providers’ notes Snapshot cross-sectional design, uncontrolled

Discussion Balancing Cost Efficiency and Cognitive Load Should there be a time limit on repeating labs? Should providers document the reason for obtaining all labs studies, including BMP and CBC? Why do teams vary in their use of repeating labs? Extending the Study Examine past discharges Incorporate severity scores/comorbidity scores