Quality of Care NL Blood Urea Six Month Update Faculty of Medicine
Update Six months ago Quality of Care NL launched a campaign to lower the number of Blood Urea tests across Eastern Health. We now have our numbers back and are happy to say your efforts to curb potentially unnecessary tests have made a direct impact on patient care! We still have work to do in reducing our overtesting, but this is a great fjrst step. Thank you for all your efforts! Here’s how the numbers break down… Faculty of Medicine
Phase 2: Use of blood urea test in general practice 01 November 2016 – 30 April 2017 1. Blood urea is usually not necessary to assess stable 4. From Nov 1 2016 – Apr 30 2017 there was a signifjcant kidney function because the e GFR is now available, drop in urea ordering. There were about 8000 fewer but is often ordered together with serum creatinine. tests/month compared to the same period of time 2015- 2016, a 46% drop compared to s. creatinine rates. 2. Quality of Care NL, using a peer comparison program and academic detailing, attempted to uncouple the 5. Your personal ordering of blood urea compared to your ordering of blood urea from s. creatinine. peers is provided in the attachment pre and post the intervention. 3. During the Quality of Care NL Campaign, the ordering of blood urea was changed: physicians are now required Click here to obtain the information on volume of kidney to provide a written order for blood urea. function testing at Eastern Health from April 2015 to April 2017, and your personal ordering. Faculty of Medicine
Phase 2: Use of blood urea test in general practice 01 November 2016 – 30 April 2017 • Although blood urea provides a measure of kidney function, it is not necessary to evaluate stable kidney function. • Serum creatinine and estimated GFR (eGFR) is suffjcient to evaluate stable kidney function; if you order a serum creatinine for this purpose, a blood urea is not necessary. • In acute kidney injury, blood urea may be useful to assess the cause. Urea that is disproportionately high compared to the rise in creatinine may be seen in conditions where there is volume depletion, hypercatabolism or bleeding into the upper GI tract. Faculty of Medicine
Kidney function tests ordered by family doctors Similar number of S. creatinine and blood urea tests 46% fewer blood urea tests than S. creatinine Faculty of Medicine
Blood urea tests ordered by family doctors 29% 42% 46% 51% 41% 51% • The number of urea tests has dropped dramatically. • On average 8,000 less tests were ordered per month compared to the same time last year. Faculty of Medicine
Comparison of top 20 family doctors by volume of blood urea tests Nov 2015 – April 2016 and Nov 2016 – April 2017 Many physicians have signifjcantly improved their blood urea ordering practices, but some are still among the most frequent orders. Faculty of Medicine
Number of kidney function tests by month by family doctors April 01, 2015 to April 30, 2017 • August 15, 2016: starting date for the new requisition. • October 07, 2016: campaign started. Faculty of Medicine
Conclusion A mutifaceted intervention resulted in 50% reduction of blood urea testing by family doctors. Thank you for your efforts in reducing potentially unecessary tests! Please Note... For more information, or for a refresher on these practice points, Quality of Care NL and the Faculty of Medicine, the Offjce of Professional Development are partnering to offer an accredited module on this topic. CME credits are available for module completion and registration will be open the week of August 14. For more information, or to register, please visit www.qualityofcarenl.ca/blog/ Faculty of Medicine
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