Many thanks to all who attended the Choosing Wisely KEG meeting last week.
Meeting minutes are below
SCCM Choosing Wisely KEG meeting June 16, 2021
Choosing Wisely: Reducing the Number of Procalcitonin Blood Draws, a Quality Improvement Project
Bethany Kummer, PharmD
Memorial Hermann Health System
- Background on PCT, interpretation, PK were reviewed. Highest sensitivity and specificity for PCT is in lower respiratory tract infections
- Memorial Hermann-TMC was identified as a top Viziant hospital for PCT use. Often ordered routinely and more frequently than clinically necessary
- PI project initiated with a goal to implement an algorithm for PCT use and reduce PCT lab draws by at least 10% across select ICUs.
- Primary endpoint: # PCT lab draws; cost of PCT lab draws
- Secondary: % PCT lab draws from medication power plans; Clinical responses resulting from PCT lab draws
- Education developed and provided to units regularly and across all shifts.
- Baseline data collected from December 1, 2019 to January 31, 2020 and also May 1, 2020 to June 30 2020 (two time periods collected to account for seasonal illnesses as well as pre/post COVID data)
- Intervention time period October 5, 2020 to December 31, 2020
- Number of ICU admissions and PCT draws were less in the post-pilot period. No difference in ICU length of stay
- Baseline demographics essentially similar
- Higher proportion of patients with admitting diagnosis of infection in the post-pilot period
- Total # PCT lab draws 1215 in 123 days across 3 units veruss 567 in 88 days across 3 units (SHIC unit was loved on 12/1)
- Median time between PCT lab draws was < 48 hours and increased to > 48 hours following pilot
- No significant difference noted in PCT ordered from medication powerplan versus not.
- There was a significant increase in number of PCT intervened on in the post-pilot phase; however, the vast majority of PCT were not acted on in either pre- or post-pilot phases
- Significant improvement in PCT considered 'appropriate' post-pilot
- Post-pilot estimated cost savings was approximately $16,000 across 3 units
- Cost of PCT not acted on was ~ $51,000 pre-pilot and ~ $31,000 post-pilot
- Overall, reduced PCT use decreased by > 50%