As you probably noticed, there have been multiple emails about the national blood collection tube shortage. What has led to this shortage? The pandemic not only increased demand for blood draws but also impacted national supply chains. The current national shortages are listed below.
Increasing inventory supply will take time, and the best way for we as physicians to help in the meantime with this shortage (expected to last until Summer 2022) is to implement conservation efforts.
However, this is also an opportunity to improve the value of care we provide to our patients. The ABIM’s Choosing Wisely initiative recommends against daily lab testing if there is evidence of clinical and lab stability. Unnecessary lab draws contribute to healthcare system costs, can increase patient discomfort, and can lead to iatrogenic anemia.
We can utilize labs with the add-on function from previous samples and then we can decide if we really need daily BMP/CBC or if we can space these out for stable patients to every other day.
Northwestern will implement the removal of the “daily 4 AM” option in EPIC on Tuesday 10/26. Lab orders can be placed one day ahead of time, and you can continue to use “routine 1 time in AM” for morning draws. Previously ordered labs prior to 10/26 will continue as “daily 4 AM”. Order sets that contain “daily 4 AM” labs will change to default “routine 1 time in AM” instead as well.
Exceptions to these rules include Heparin/Argatroban/Warfarin monitoring (Anti Xa, aPTT, INR, etc).
One tool to offset this is the temporary storyboard notification tab in EPIC to help catch labs that may be missing as listed on the left side of the patient’s EPIC chart as below.
You can also use the MyList column to quickly view which of your patients have labs ordered for the next morning on your list patient list home page as below. Make sure to double-check that you have necessary labs ordered for your patients before you sign out for the day by looking at the morning draws tab.
We know this has been a stressful time for everyone with the pandemic, but we can continue to provide the best care possible for our patients by using our resources more judiciously and switch from a reflexive approach to ordering daily CBCs and chem panels to a clinical value-based approach.
-Dylan