Financial impact of a targeted reduction in cardiac enzyme testing at a community hospital

• Main Authors: Li Zhang, Anne M. Sill, Ilene Young, Sabreen Ahmed, Maria Morales, Sapna Kuehl
• Format: Article
• Language: English
• Published: Taylor & Francis Group 2016-10-01
• Series: Journal of Community Hospital Internal Medicine Perspectives
• Subjects: quality improvement; cost reduction; CK-MB; myoglobin; troponin; acute coronary syndrome
• Online Access: http://www.jchimp.net/index.php/jchimp/article/view/32816/pdf_154

Objectives: Nearly one-third of healthcare costs are potentially avoidable and would not compromise medical care if eliminated. Therefore, we sought to evaluate the financial impact of reduction in use of creatinine kinase (CK)-MB and myoglobin tests after removing them from the cardiac enzyme order set at a community hospital. Methods: Grand rounds were held, and an email notification was sent to de-emphasize the use of CK, CK-MB, myoglobin, SGOT (glutamic-oxaloacetic transaminase), and SGPT (serum glutamic-pyruvic transaminase) in acute coronary syndrome (ACS) work up. The above tests were removed from the pre-checked cardiac enzyme order set in the computerized physician order entry on February 13, 2014. The tests continued to be available, but needed to be ordered individually. The mean monthly volume of cardiac enzyme tests for 12 months after this intervention was compared with the mean monthly volume of 12 months before the change. Total cost savings were calculated. Results: After the intervention, the number of CK, CK-MB, myoglobin, SGOT, and SGPT tests utilized for ACS workup decreased dramatically (p<0.001). The volume of troponin testing remained the same (p=0.283). The total annual savings of billable charges to healthcare payers was $463,744.7. Conclusions: Removal of CK-MB, myoglobin, CK, SGOT, and SGPT tests from cardiac enzyme order sets can successfully reduce unnecessary laboratory testing for ACS workup, leading to significant cost savings to the healthcare system.