Download Cost analysis project : Ordering Magnesium and Phosphorus

Cost analysis project :
Ordering Magnesium and
Phosphorus
Pouneh Nasseri
R2
12/17/12
• Research Objective : To investigate how
often magnesium and phosphorus are ordered
, if it has an appropriate indication , and to
determine the excess cost associated with
inappropriate orders.
METHODS
• Study site: UCI medical center
• Patient population : 50 Patients admitted to UCI
ward team . All adults > 18 yrs of age
• Study design :
– Retroperspective chart review of all patients admitted
to UCI ward teams for a 4 day period
– Determining if admission diagnosis had an indication
for ordering mag and phosphorus
– Interviewing the seniors of the team to analyze if
patient had other indications for ordering mag and
Phosphorus , and if daily monitoring of normal values
was necessary.
Indications for ordering Magnesium
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Renal failure patient : Acute, chronic
Alcoholism
Medications : PPI , Diuretics
Other electrolyte abnormalities: Hypocalcaemia,
hypokalemia (especially refractory)
Neuromuscular disease
Arrhythmias (ventricular)
Acutely ill diabetics
Malnutrition/malabsorption
Diarrhea
Indications for ordering Phosphorus
• Malnutrition/malabsorption
• Other electrolyte abnormalities (hypocalcemia,
hypomagnesium , hypokalemia)
• Rhabodomyolysis
• Alkalosis/ Acidosis
• Malignancy/ Tumor lysis syndrome
• Renal failure: acute , chronic
• Acutely ill diabetic
• Hyperglycemia
• Hyper/hypo parathyroidism
• Sepsis
• Alcoholism
• Diarrhea/ laxative abuse/ bowl prep for colonoscopy
Simple guideline for ordering Mag
and Phos
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Group 1: Renal failure ( acute/chronic )
Group 2: Diabetics ( Acutely ill/ hyperglycemia )
Group 3:High risk patients for malnutrition state
Group 4: Diarrhea/laxative/bowel prep
Group 5: Electrolyte abnormalities
Group 6: Cancer patients (active cancer)
Group 7: Alcoholics
Group 8: Acutely ill patients : Sepsis, neurological
symptoms and deficits, generalized weakness,
Arrhythmias .
COST At UCI
• Magnesium : $5
• Phosphorus : $5
Results
• Out of 50 patients analyzed on 7 did not have
their phosphorus or magnesium checked during
their hospitalization and all 7 did not have any
indications for checking magnesium and
phosphorus based on the guidelines made
• Out of 43 who had magnesium and phosphorus
ordered 8 (18.6%) had no indications for ordering
Mag and Phos and 35 (81.4%) had one or more
indications to order initial magnesium and
phosphorus
RESULTS
Some patient meet 2 or more criteria for ordering labs
• Group 1: Renal failure ( acute/chronic ) 7
• Group 2: Diabetics ( Acutely ill/ hyperglycemia ) 2
• Group 3:High risk patients for malnutrition state 5
• Group 4: Diarrhea/laxative/bowel prep
• Group 5: Electrolyte abnormalities
6
6
• Group 6: Cancer patients (active cancer) 4
• Group 7: Alcoholics 4
• Group 8: Acutely ill patients : Sepsis, neurological
symptoms and deficits, generalized weakness,
Arrhythmias . 9
RESULTS
• Out of 43 patients only 10 patients had
abnormalities in either magnesium or
phosphorus (or both)
• Out of these 10 patients , 5 continued to have
daily abnormal values.(Out of those 5 : 3 were
dialysis patients , 1 was malnourished, 1 was
septic)
• Out of 43 patients 33 patients had repeating
labs ordered.
RESULTS
• 18.6 % of patients had no indication of initial
order of mag and phos ($80)
• 65% of patient had unnecessary daily Mag and
Phos ordered
• Daily unnecessary cost was around $ 250 dollars
• Extrapolated to a week = $1750
• Extrapolated to a year = $ 91,250
Conclusion
• We as residents do have a culture of ordering
unnecessary daily labs
• In regards to Magnesium and phosphorus, overall our
initial order of magnesium and phosphorus seems to
be indicated
• However we repeat labs even if values are normal and
also when underlying condition causing abnormal
values are being treated or have resolved.
• Even though Magnesium and phosphorus do not cost
much , in the bigger picture everything adds up to our
overall high cost of healthcare
Conclusion
• Limited study
– The cost of Mag and Phos is the cash value
without insurance coverage
– It’s a snap shot of only 4 days. Can be attending
/resident based
– The Extrapolation is not really a valid
representation
– Small sample size