An electronic health record-based solution to reduce the volume of CBC differentials performed on inpatients.

Objective: We sought to investigate the use of same-day, repeat complete blood cell count (CBC) with differential orders in a large pediatric institution and design an intervention to limit CBC with differential testing and, thereby, manual differential performance to once per calendar day, without placing a burden on ordering clinicians.

Methods: We created a seamless electronic health record (EHR)-based back-end workflow that reaccessions CBC with differential orders to a CBC without differential if a CBC with differential has been resulted within that calendar day. Clinicians have an opportunity to override at the time of test order entry in the EHR.

Results: Repeat CBC with differential orders originated predominantly in intensive care units (ICUs) and oncology inpatient units and accounted for 18% of all CBC with differential orders. Implementation of our EHR workflow led to an average annual reduction of 9% in CBC with differential tests and a 16% reduction in manual differentials performed. This change amounts to a combined annual cost savings (direct cost of testing plus laboratory technologist time) of approximately $45 000 and improved CBC with differential test turnaround times.

Conclusions: Our EHR-based solution resulted in a substantial and sustained decrease in CBC with differential tests and manual differential slide reviews performed in a critically ill pediatric population. This approach is a potential alternative to traditional educational and other clinician-dependent stewardship interventions that aim to improve test utilization.