Abstract
Purpose
The red blood cell (RBC) folate test is a laboratory test with limited clinical utility.
Previous attempts to reduce physician ordering of unnecessary laboratory tests, including
folate levels, have resulted in only modest success. The objective of this study was
to assess the effectiveness and impacts of restricting RBC folate ordering in the
electronic health record (EHR).
Methods
This was a retrospective observational study that took place from January 2010 to
December 2016 at a large academic healthcare network in Toronto, Canada. All inpatients
and outpatients who underwent at least 1 RBC folate or vitamin B12 test during the
study period were included. Ordering an RBC folate test was restricted to clinicians
in gastroenterology and hematology. The option to order the test was removed from
other physicians’ computerized order entry screens in the EHR in June 2013.
Results
RBC folate testing decreased by 94.4% during the study, from a mean of 493.0 ± 48.0
tests per month prior to intervention to 27.6 ± 10.3 tests per month after intervention
(P < .001).
Conclusions
Restricting RBC folate ordering in the EHR resulted in a large and sustained reduction
in RBC folate testing. Significant cost savings, estimated at more than a quarter
of a million Canadian dollars over 3 years, were achieved. There was no significant
clinical impact of the intervention on the diagnosis of folate deficiency.
Keywords
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Article info
Publication history
Published online: May 02, 2018
Accepted:
March 29,
2018
Received in revised form:
March 29,
2018
Received:
February 22,
2018
Footnotes
☆Funding: None.
✯✯Conflicts of Interest: None.
✯Authorship: Dr. MacMillan takes full responsibility for the work as a whole, including the study design, access to data, and the decision to submit and publish the manuscript. All authors contributed to the writing and revising of the manuscript.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
