1Cairns Base Hospital (Queensland Health), Cairns, Australia

Aim: To explore the cost saving and clinical impact of abbreviated testing schedule.
Background: Dialysis patients undergo routine monthly blood tests. Most units have a monthly schedule of testing. We amended our unit’s schedule by making simple changes. Routine 20 analyte chemistry (chem20) was replaced by chem5 but quarterly chem20 was retained. Quarterly B12/folate and PTH were reduced to biannually. Viral serologies and urea was reduced to annually. Quarterly CRP was removed from routine testing. We hypothesised these changes would not have significant clinical impact.
Methods: Cost of routine pathology testing was provided by Pathology Queensland. We then calculated the cost per patient/year and the cost difference for both our old and new schedule. The hospital database was used to quantify all hospital admissions 12 months before and after the schedule change. We defined a significant hospital stay as > 1day. Paired T testing was used to compare the difference.
Results: The cost of the original pathology test regime was $555.58 per patient per year. The cost of the new pathology testing regime was $306.31 per patient per year. There were 287 prevalent dialysis patients. This represented a total cost reduction of $71540.49 over 12 months.
There was no significant difference in mean hospital admissions for each patient, before and after the testing schedule change (1.54 in 2016 vs 1.31 in 2017; t = 1.8612, p = 0.06).
Conclusion: Rationalising the pathology testing schedule in dialysis can result in significant cost savings for the health service. These data suggest that outcomes can be monitored less frequently, and biochemistry can be removed from routine monitoring without adversely altering admission rates.

Dr Catherine Wilkinson is a advanced trainee in nephrology, currently based at Cairns Hospital.

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