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Heart Health

Unnecessary Blood Tests Waste Money

Researchers at Johns Hopkins Bayview Medical Center used two relatively simple tactics to significantly reduce the number of unnecessary blood tests to assess symptoms of heart attack and chest pain and to achieve a large decrease in patient charges.

A release from the center explains that the team provided information and education to physicians about proven testing guidelines and made changes to the computerized provider order entry system at the medical center, part of the Johns Hopkins Health System. The guidelines call for more limited use of blood tests for so-called cardiac biomarkers. A year after implementation, the guidelines saved the medical center an estimated $1.25 million in laboratory charges.

In this case, part of the focus was on tests to assess levels of troponin, a protein whose components increase in the blood when heart muscle is damaged. Frequently, troponin tests are repeated four or more times in a 24-hour period, which studies have suggested is excessive, and they are often done along with tests for other biomarkers that are redundant.

In a report published June 28th 2014 in the Journal of General Internal Medicine, the research team describes how these interventions reduced overuse of troponin and other biomarker testing without compromising patient care. If adopted widely, the team says, cost savings could be substantial.

The release quotes report author Jeffrey C. Trost, M.D., an assistant professor of medicine, director of the cardiac catheterization laboratory and co-director of interventional cardiology at Johns Hopkins Bayview Medical Center, as saying, “This study has broader implications for the health care system, as most hospitals continue to redundantly test people for chest pain and other symptoms,” says report author. “Implementing our interventions could save patients and society a significant amount of money, potentially several billion dollars.”

For the study, the Johns Hopkins team set out to lower the rate at which doctors order cardiac biomarker testing for the diagnosis of acute coronary syndrome by basing the desired rate on scientific evidence.
In 2010, the researchers report, more than 17 million patients with chest pain visiting an emergency department in the United States received cardiac biomarker testing.

Between August and October 2011 at Johns Hopkins Bayview Medical Center, the team introduced written institutional guideline and changes to the computerized provider order entry system designed to reduce redundant testing.

The new guidelines suggest ordering troponin alone, without creatine kinase or creatine kinase-MB, for patients suspected to have acute coronary syndrome. It specifies that troponin should be assessed no more than three times over 18 to 24 hours.

Internists and emergency department doctors attended informational sessions to learn the guidelines, and all received quick reference cards summarizing them.

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