Millions of blood tests are ordered each year for patients in Canadian intensive care units (ICUs)—this practice costs between $400 million to $1 billion each year. Although some of these tests may be indicated based on clinical information, it is also likely that many are ordered unnecessarily.
Extensive and often unnecessary blood test ordering is often based on longstanding practice patterns that have never been challenged. Although these patterns exist throughout the hospital, they are prominent in the ICU due to high patient acuity and complexity. Studies that have assessed variation in blood test ordering practices among ICUs suggest that there is no correlation between the number of tests done and patient outcomes. However, there are few studies that directly examine this relationship. The practice of ordering more blood tests may offer no advantage to patients--or worse - it may be associated with anemia, avoidable blood transfusions, and increased costs.
We propose a comprehensive research program (RUBIC - Reducing Unnecessary Blood tests In the Critically ill) aimed at reducing the number of unnecessary blood tests ordered in the ICU. The first step of this program is a prospective audit of current practice. We will document the blood test ordering practices during the first week of ICU admission for all ICU patients. We will describe which tests are ordered, how many are done per patient-day, how much blood is collected during each draw, whether blood tests are ordered routine-priority or more urgently (stat), and the cost of these tests. We will investigate both patient and centre factors that are associated with variability in these practices, including a process evaluation of centre-specific blood test ordering procedures. The results of this analysis will inform a multi-faceted intervention aimed at decreasing the number of unnecessary blood tests ordered in the ICU.