Quality Improvement

Cost Conscious Medical Care

By Jeff DellaVolpe

As we enter the era of the Affordable Care Act roll out, despite the uncertainty, one truth remains: all of us as healthcare professionals are going to have to do more with less. However, the reality may be that cost efficiency is something that many of us are inadequately prepared to carry out. Throughout much of our training, cost conscious medical care is often something that was encouraged in theory, with little to no practical training on how to do so. Take the case of the arterial blood gas (ABG): this rapid and straightforward test can be invaluable in the work up and management of critically ill patients when directed towards specific clinical questions. However, too often, it becomes yet another component of the battery of tests ordered and largely disregarded on a daily basis under the heading of “morning labs”. Our study attempted to introduce a framework for ordering ABGs that would help re-introduce the test as a guide for clinical decision making by having users enter the indication for ordering a test. Simply doing so reduced the number of blood gases ordered by nearly 25% with no change in mortality, with an annual institutional savings of $87,565. The effect from the patient’s perspective is even more significant, as fewer blood gases meant fewer sticks, fewer arterial lines, and less pain.

It is always easy to say that healthcare is expensive and that the cost should be reduced. Sometimes lost in that statement is the reality that rational clinical decision-making can facilitate more effective as well as more efficient clinical care.

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