Reduction of simultaneous ordering rate of high sensitivity C-reactive protein and erythrocyte sedimentation rate in a veteran affairs healthcare system.

Abstract

It is widely recognized that the ESR (Erythrocyte Sedimentation Rate) and hs-CRP (C-Reactive Protein) are comparable inflammatory markers. In this reported veteran population, there is a significant correlation between the two assays. The simultaneous ordering of ESR and hs-CRP for evaluation of acute inflammation is unnecessary and wasteful. Various hospitals have implemented processes to reduce co-ordering habits through best practice advisories (BPAs) and/or educational interventions. In this retrospective study spanning twelve months, the Northern California Veteran Affairs Hospital System had a co-ordering rate of approximately 72% (number of hs-CRP orders with a co-ordered ESR compared to the total number of hs-CRP orders). After implementing a best practice ordering advisory and providing education to the clinical teams, there was a significant decrease in co-ordering of the assays (-34%, p-value = 0.00036). There was also a significant decrease in standalone ESR ordering and standalone hs-CRP ordering (p-value = 0.0003 and 0.0042, respectively). Departments receiving both interventions, an ordering advisory and education, had the largest decrease in co-ordering habits, the largest decrease seen being more than 56%. Proper implementation of ordering advisories paired with education results in better test utilization and lower co-ordering rates.