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Original article
Improving serum calcium test ordering according to a decision algorithm
  1. Daniel K Faria1,
  2. Leandro U Taniguchi2,
  3. Luiz A M Fonseca3,
  4. Mario Ferreira-Junior4,
  5. Francisco J B Aguiar2,
  6. Arnaldo Lichtenstein4,
  7. Nairo M Sumita1,
  8. Alberto J S Duarte1,
  9. Maria M Sales1
  1. 1Divisão de Patologia Clínica, Departamento de Patologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
  2. 2Discipline of Emergency Medicine, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
  3. 3Department of Internal Medicine, Clinical Immunology and Allergy Service, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
  4. 4Department of Internal Medicine, General Practice and Propedeutics Service, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
  1. Correspondence to Dr. Daniel K Faria, Division of Clinical Pathology - Department of Pathology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Av. Dr. Enéas de Carvalho Aguiar, 155 Prédio dos Ambulatórios 2º Andar bloco 8. São Paulo 05403-010, Brazil; danielkanaan28{at}gmail.com

Abstract

Aim To detect differences in the pattern of serum calcium tests ordering before and after the implementation of a decision algorithm.

Methods We studied patients admitted to an internal medicine ward of a university hospital on April 2013 and April 2016. Patients were classified as critical or non-critical on the day when each test was performed. Adequacy of ordering was defined according to adherence to a decision algorithm implemented in 2014.

Results Total and ionised calcium tests per patient-day of hospitalisation significantly decreased after the algorithm implementation; and duplication of tests (total and ionised calcium measured in the same blood sample) was reduced by 49%. Overall adequacy of ionised calcium determinations increased by 23% (P=0.0001) due to the increase in the adequacy of ionised calcium ordering in non-critical conditions.

Conclusions A decision algorithm can be a useful educational tool to improve adequacy of the process of ordering serum calcium tests.

  • calcium metabolism disorder
  • clinical practice guideline
  • clinical laboratory service

https://doi.org/10.1136/jclinpath-2018-205026

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    Footnotes

    • Handling editor Tahir S Pillay.

    • Contributors All authors contributed equally for the production of this manuscript.

    • Funding Fundação Faculdade de Medicina, São Paulo, Brazil, provided individual scholarships to all authors of this article.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval The study was approved by the Research Ethics Committee of the hospital.

    • Provenance and peer review Not commissioned; externally peer reviewed.