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Table 5 Summary of secondary outcomes for ‘placebo’ A&F studies (RCTs, controlled and uncontrolled before after studies)

From: Audit and feedback to improve laboratory test and transfusion ordering in critical care: a systematic review

Study

Outcome

Absolute Δ

Time 1- Time 2

Reported

p value

Absolute Δ

Time 1- Time 3

Reported

p value

Paes 1994

Lab test ordering: costs for superficial cultures

-$21.49/patient

NR

  

Hendryx 1998

Lab test ordering:

    

Mean total LOS (days)

Treatment= -3.2

Control = -0.6

NS

  

Mean ICU LOS (days)

Treatment= -2.1

Control = -0.3

NS

  

Mortality rate (*unclear if ICU or hospital)

Treatment = +0.02

Control = -0.14

NS

  

Mean infectious nosocomial events per 100 ICU Days

Treatment = +0.1

Control= -1.0

NS

  

Merlani 2001 and Diby 2005

Lab test ordering:

    

Unit population, Mean stay (days)

-0.3

0.26

-0.3

0.26

Unit population, Mortality (%)

+0.1%

0.80

-0.5%

0.80

Savings (per patient day)

Pilot period:

SFr 34.8

(or £14.15)

 

Consolidation period: SFr 68.4

(or £27.81)

 

Beland 2003a

Lab test ordering:

    

Average LOS (days)

+4.9

NR

+9.4

NR

Total charge for unordered tests

(average cost per patient per day in ICU)

+$4564.80

(+$42.32)

NR

+$3246.75

(-$21.91)

NR

Petäjä 2004b

Transfusion ordering:

    

LOS (NR, Calculated)

Days of care/all admissions (days/patient)

+0.1

NR

-1.2

NR

Schramm 2011

Lab test and transfusion ordering:

    

Median ICU LOS (Days)

0

0.010

0

0.010

Hospital mortality (%)

-1.6%

0.029

-8.3%

0.029

Masud 2011c

Transfusion ordering:

    

Observed: expected operative mortality index for isolated CABG

Δ 2006-2007= -0.07

Δ 2007-2008= -0.05

NR

NR

Δ 2006-2008= -0.12

NR

Average LOS for CVICU patients (Days)

Δ 2007-2008= -0.21

NR

  

Estimated expense for all blood products

Δ 2007-2008 = -$928 125

NR

  

CRBSI

Δ 2007-2008= +0.3

NR

  

VAP Incidence

Δ 2006-2007= 0

Δ 2007-2008= -1

NR

NR

Δ 2006-2008= -1

NR

Surgical site infection rate

    

CBGB risk 0,1

Δ 2006-2007= -0.66

Δ 2007-2008= 0.46

NR

NR

Δ 2006-2008= -0.2

NR

CBGB risk 2

Δ 2006-2007= -2.49

Δ 2007-2008= -0.94

NR

NR

Δ 2006-2008= -3.43

NR

CBGC risk 1

Δ 2006-2007= -5.13

Δ 2007-2008= 0

NR

NR

Δ 2006-2008= -

NR

CBGC risk 2,3

Δ 2006-2007= 0

Δ 2007-2008= 0

NR

NR

5.13

Δ 2006-2008= 0

NR

Arnold 2011

Transfusion ordering:

    

ICU Mortality (%)

-4%

0.76

-9%

0.76

Hospital Mortality (%)

-4%

0.90

+2%

0.90

Beaty 2013d

Transfusion ordering:

    

CSICU LOS (Days)

    

Non-transfused (n=368)

-0.1

0.21

-0.5

0.21

Transfused (n=144)

-1.4

0.22

0

0.22

Total Hospital LOS

    

Non-transfused (n=368)

0

0.11

-1

0.11

Transfused (n=144)

-3

0.36

+1

0.36

Observed in-hospital mortality

-4.8%

0.02

-5.5%

0.02

Gutsche 2013

Transfusion ordering:

    

Mean ICU LOS (hours)

-1.5

0.90

  

Mean Hospital LOS (days)

-0.9

0.24

  

30 days-mortality

-1.5%

0.42

  

Yeh 2015

Transfusion ordering:

    

Mortality (%)

+3%

0.60

0%

0.60

Median ICU LOS (days)

-1

0.57

3

0.57

Median hospital LOS (days)

+1.5

0.48

+9

0.48

Murphy 2016e

Lab test & transfusion ordering:

    

ICU Mortality Rate (%)

-1.7%

<0.05

-1.2%

<0.05

Hospital Mortality Rate (%)

-1.8%

<0.05

-1.5%

<0.05

Mean ICU length of stay (units NR)

-0.1

NS

0

NS

Estimated total gross direct cost savings

  

$1 942 735

 

Estimated net cost savings (accounting for incentive pay-out)

  

$1 544 095 (or $772 048 per year)

 
  1. Secondary Outcomes; length of stay (LOS), mortality, infection and expenditure or savings. ABGs arterial blood gases, CABG coronary artery bypass grafting, CRBSI catheter-related bloodstream infection, CSICU cardiac surgery ICU, CVICU cardiovascular ICU, ICU intensive care unit, NR not reported, NS not significant, RCBs red blood cells, T1 time 1 (baseline), T2 time 2 (implementation), T3 time 3 (follow-up), VAP ventilator-associated pneumonia
  2. aNR whether average represents mean or median
  3. bT2: after audit system activated; T3: audit system + post-feedback
  4. cCRBSI = hospital level, VAP = “incidences of VAP for randomly sampled quarters”, surgical site infections = cardiovascular surgery service
  5. dT2: weekly, group feedback; T3: weekly, individual feedback as a group; unclear if LOS values are means or medians
  6. eEstimated overall savings from reduction in ABGs, RBCs and Chest X-rays
  7. *Notes: No relevant secondary outcomes reported for: Solomon 1988, Wisser 2003, Calderon-Margalit 2005; p values are those reported in studies