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Preoperative Testing Guidelines Overuse of INR in addition to PT Testing in Medical Inpatients
Bemidji State Univeristy, US has reference to this Academic Journal, Overuse of INR in addition to PT Testing in Medical InpatientsKevin Pham, PGY2GuidelinesJAMA. 1989;262(17):2429.Preoperative TestingLiver function testing (including INR/PT) only if there are suspicions in consideration of liver disease based on prior abnormal LFTs, history, in addition to exam.Nature Clinical Practice Gastroenterology & Hepatology. 2007 ;(4) :266-276
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MethodsCross sectional analysisSample size n=20 Randomly review current medical inpatient charts until sample size is attained.Only one INR/PT per patient closest so that admission date was included in sample. Inclusion criteria: medical inpatients, INR testing during current admissionExclusion criteria: surgical, MICU, SICU, heme/onc, OB/GYN inpatients, in addition to those without INR/PT testing.ResultsTotal charts review: 28INR/PT testing absent: 8INR/PT testing present: 20Indicated: 10Not Indicated: 10Results10/20 INR/PT tested (50%) were not indicated1/10 INR/PT tested (10%) of the ?not indicated? group was abnormal (based on UCI Medical Center laboratory reference ranges).Abnormal INR/PT did not have clinical significant in addition to did not change management.
ResultsIndications in consideration of inappropriate INR/PT testing were unknown since they were not documented.Inappropriate INR/PT ordered by ED: 4/10 (40%)Inappropriate INR/PT ordered by medical residents: 6/10 (60%)ResultsIndications of appropriate INR/PT testing1/10 in consideration of Coumadin bridging in consideration of LV thrombus3/10 in consideration of malnutrition in addition to invasive procedure3/10 in consideration of cirrhosis in addition to invasive procedure3/10 in consideration of active bleedingCostCost per INR/PT testing: $8.45Charge per test: $59.86Patient volume 2013 (Tower): 3,343Test volume 2013 in consideration of tower patients: 8,343Assuming 50% of INR/PT testing are inappropriate as demonstrated by these data, potential cost annually due so that inappropriate INR/PT is $35,249.Inappropriate charge so that patient is $249,705.
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ConclusionThe incidence in addition to cost of inappropriate INR/PT testing is high.Increased awareness of guidelines in consideration of INR/PT testing may reduce the incidence in addition to cost.ReferencesErban, S.B., et al. Routine use of the Prothrombin in addition to Partial Thromboplastin Times. JAMA. 1989;262(17) :2429.Hanje, A.J in addition to Patel, T. Preoperative evaluation of patients alongside liver disease. Nature Clinical Practice Gastroenterology & Hepatology. 2007 ;(4) :266-276
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