The project goals were to describe the frequency of routine CBC testing and to identify clinical scenarios in which testing changes patient management. By ultimately identifying scenarios in which routine lab testing can be safely avoided, we promote health care value and reduce patient discomfort.
Jonathan Lee, MD
Neelaysh Vukkadala, MD
Beth Israel Deaconess Medical Center, Brigham and Women’s Hospital, UCSF, University of Chicago, University of Michigan
The goal of this study was to identify situations in which routine complete blood count (CBC) testing could be avoided in patients with community-acquired pneumonia (CAP). This was a retrospective study of 50 patients with CAP. Vital signs, lab results, assessment and plan data, and computerized provider order entry logs were collected to determine if a lab result or clinical finding changed clinical management. Clinical stability was defined based on Patient Outcomes Research Team study criteria. There were 94 CBCs obtained after admission, of which only 6 were associated with management changes. Only two of these instances involved management changes related to patients’ pneumonia, while the other cases represented chronic illnesses. Among all patients, the positive likelihood ratio of a post-admission CBC predicting a change in clinical management was low (1.12 [95% confidence interval, 0.86-1.44]). Low utility of CBC testing after admission may represent an opportunity to improve the value of care in CAP patients.