1. BMP Ordering Practice Among UCI Wards Teams
Prepared by: Michael Rochon-Duck
UCI Internal Medicine
December 17, 2012

2. Motivation and Background
The basic metabolic panel is a “routine lab” frequently ordered by IM wards teams
QUEST makes it easy to order repeating labs
Each BMP costs $14

3. Study Design and Data Sources
A cross-sectional study of patients admitted to the six UCI internal medicine wards services on December 16, 2012
For each patient, the following was recorded:
Date of admission
Current care team
Number of BMP or CMP resulted on each day of hospital stay
If patient has order for repeating labs

4. Analytical Methods Exploratory plots and statistics
Comparison of the number of BMPs between patients with an order for repeating daily BMPs and those without

10. Discussion Findings of this study Limitations
Longer-stay patients tend toward daily BMP, costing $14 per patient per day
Teams vary in their use of repeating labs
Automatically repeating BMP trends toward increasing utilization
Limitations
No criteria exist for appropriate usage of BMP
Because BMP is so routine, justification for ordering the test is seldom documented in providers’ notes
Snapshot cross-sectional design, uncontrolled

11. Discussion Balancing Cost Efficiency and Cognitive Load
Should there be a time limit on repeating labs?
Should providers document the reason for obtaining all labs studies, including BMP and CBC?
Why do teams vary in their use of repeating labs?
Extending the Study
Examine past discharges
Incorporate severity scores/comorbidity scores