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

2. 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.

3. 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.

4. 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

5. 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

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

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

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

9. Combined excessive costs
Dollars USD
Hospital Day

10. Projected Costs
6 Teams
Dollars USD
1 week
1 year

11. 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