Have you already tried to address the over-utilization of some tests in your hospitals?
For example, how do you manage the over-utilization of erythrocyte sedimentation rate and fibrinogen for inpatients?
If you have some experience, tell us was it sucessful? Tell us how you did it. Let us share our thoughts, ideas and experiences and mutually benefit one from another.
I look forward to hear from you.
Dear Ana,
unfortunately this is not my interest.
Best regards
Grażyna Adler
Dear Ana
Unfortunately I don't use erythrocyte sedimentation rate or fibrinogen quantification with athletes.
Best regards
Lázaro
Hi Ana,
At our hospital in 2011, we introduced this policy: ESR and a C-reactive protein (CRP) will not be performed if ordered simultaneously.
1. If both CRP and ESR are ordered simultaneously, only the CRP will be performed. This applies to both inpatients and outpatients.
2. CRP is available 24/7. ESR will NOT be available on evenings and nights, except for urgent requests from Emergency Department.
3. If an ESR is ordered as the only test, the clinical indication needs to be provided.
Additional information can be obtained from the New Zealand Best Practices Advisory Committee web site: www.bpac.org.nz
jim
Dear Ana,
In most clinics and Hospitals in Nigeria, we still use ESR mostly, Clinicians have really not tuned to Fibrinogen or CRP. They are regarded as special tests probably due to cost, since most patients have to pay directly for hospital services. Our Health Insurance scheme is still at the teething stage,
Ana
CRP has largely replaced ESR and is available 24/7. CRP is clearly overused and the change values are not known to the users. I can get you data if you want some.
Best regards
Bill
Thanks, this is interesting and useful. Data and welcome!
Indications for ESR are (according to www.aafp.org/afp/1999/1001/p1443.html):
- temporal arteritis,
- polymyalgia rheumatica
- rheumatoid arthritis.
I am hoping to allow the use of ESR only for these indications and to limit the use of ESR all other purposes, in my hospital.
This is clearly overused test. Anyone who has some other examples of successful reduction of lab tests is invited to share with us his/her experience.
Ana-Maria Simundic
I have just found this very useful free resource at The New Zeeland website owned by The Best Practice Advocacy Centre New Zealand (an independent, not-for-profit organisation).
Link: http://www.bpac.org.nz/Series/schedule-guidelines.aspx
This document could be of great help in managing test requests. It contains advice on the proper use of ESR, for example.... Enyoj!
Dear Ana:
We´re trying to minimize the use of ESR, During the emergency, only if the doctor is looking for diagnose arthritis or related diseases. However is too difficult to make understand physician that question.
THanks for the guides!!!!
Best regards
Graciela
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