SHM Converge Scientific Abstract ePoster Gallery-A Campus-Wide Best Practice Advisory to Reduce Potentially Unnecessary CBCS

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This project evaluated whether a campus-wide Epic Best Practice Advisory (BPA) could reduce unnecessary complete blood count (CBC) orders across four NYU inpatient hospitals. A multidisciplinary team of clinicians, informatics staff, and operational leaders designed an alert that fired when two recent CBCs within 72 hours suggested stable labs and the next CBC was likely low-value. “Potentially unnecessary” CBCs were defined by normal white blood cell counts, hemoglobin remaining at or above 8 g/dL without changing by more than 1 g/dL, and normal platelet counts.<br /><br />Over 2.5 years, the BPA fired 193,000 times. In nearly 37,000 cases, users chose not to order a CBC after the alert, leading to a 20% reduction in CBC orders. The intervention was implemented across NYU Langone, NYU Orthopedic Hospital, NYU Brooklyn, and NYU Long Island hospitals.<br /><br />The authors estimate that the reduced ordering translated into substantial cost savings, ranging from about $375,000 to $1.1 million depending on the assumed cost per CBC. They also note that unnecessary repeat lab testing is common and can contribute to patient discomfort, hospital-acquired anemia, transfusions, longer stays, and higher costs.<br /><br />Top free-text reasons entered by clinicians when overriding the alert included “trend,” “Covid,” “monitor,” and “trending,” suggesting many orders were driven by perceived clinical need or routine monitoring. The team plans targeted education for units with lower BPA success, improved reason selection, and refinement of the alert criteria and lockout period. Future work will also assess whether the reduction in CBC testing preserved quality of care.

Asset Subtitle

Tahir H. Malik

Meta Tag

Author List Archana Saxena, Cecilia Yang, James Davydov, Jonathan Austrian, Mario Legaspi, Tahir H. Malik

Category Innovations

Concept Blood Count

Concept Best Practice Advisory

Concept Laboratory Utilization

Concept CBC Ordering

Concept Clinical Harm

Distinguished Non-Finalist

Presenter Organization New York University, Internal Medicine

Presenting Author Tahir H. Malik

Track Quality Improvement

Keywords

Epic BPA

CBC orders

inpatient hospitals

NYU Langone

clinical decision support

laboratory utilization

alert fatigue

cost savings

repeat testing

hospital quality improvement

Blood Count

Best Practice Advisory

Laboratory Utilization

CBC Ordering

Clinical Harm