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Cost-analysis Project: The Daily CBC

This project assesses the excessive ordering of Complete Blood Counts (CBC) and CBC with differentials in a hospital ward. The study defines appropriate indications for their use, identifies associated costs, and monitors ordering practices over one week. Findings reveal a significant excess cost of $1,510, extrapolated to yearly totals of $471,120 across all ward teams. The study highlights the need for improved ordering practices and suggests that Hemoglobin and Hematocrit tests may be a more cost-effective alternative for patient monitoring.

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Cost-analysis Project: The Daily CBC

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  1. Cost-analysis Project: The Daily CBC Nicole Zanin DSR 2 May/June 2012

  2. The Plan • Background: Residents order too many CBCs and CBCs with differentials • Plan: • Define appropriate indications for CBCs and CBCs with diff. • Identify the cost of a CBC, CBC with diff, and H&H at UCI. • Monitor the CBC and CBC with diff ordering practices of one UCI ward team over a week duration. • Tally the number of inappropriately ordered CBCs and CBC with diffs and the excess cost associated with these inappropriate orders.

  3. Indication for CBC • On admission • Signs or symptoms of new infection during admission • Signs or symptoms of new anemia during admission • Active bleed • Monitoring thrombocytopenia • Monitoring leukocytosis: leukemic patient undergoing plasmaphoresis or an infected patient.

  4. Indication for CBC with Diff • On admission • Signs or symptoms of a new infection suspected after admission • Monitoring leukopenia

  5. Indication of Hemoglobin and Hematocrit • Monitor hemoglobin in actively bleeding patient. • Post-transfusion.

  6. Costs • CBC: $54 • CBC with diff: $65

  7. The Results • Day 1 • 0 CBC ordered. 1 indicated. • 5 CBC with diff ordered. 0 indicated. • Excess Cost: $315 • Day 2 • 0 CBC ordered. 0 indicated. • 5 CBC with diff ordered. 3 indicated. • Excess Cost: $130 • Day 3 • 0 CBC ordered. 0 indicated. • 5 CBC with diff ordered. 2 indicated. • Excess Cost: $195 • Day 4 • 0 CBC ordered. 0 indicated. • 5 CBC with diff ordered. 2 indicated. • Excess Cost: $195 • Day 5 • 0 CBC ordered. 0 indicated. • 4 CBC with diff ordered. 1 indicated. • Excess Cost: $195 • Day 6 • 0 CBC ordered. 2 indicated. • 5 CBC with diff ordered. 1 indicated. • Excess Cost: $240 • Day 7 • 0 CBC ordered. 2 indicated. • 5 CBC with diff ordered. 1 indicated. • Excess Cost: $240

  8. The Results • Total Excess Cost in CBC and CBC with Diff ordering on a ward team over one week= $1510 • Extrapolated to a year= $78,520 • Extrapolated to all ward teams over a year= $471,120

  9. Comments • Lots of limitations to my study! • I think we should order more H&Hs since they cost less ($40) and contain the information we are usually looking for in repeat labs. • CBCs with differential are rarely needed more than once. • CBCs and CBCs with differentials cost significantly less than other lab tests (i.e. BMP, CMP, magnesium, phosphorus, INR, PTT).

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