UCSF Center for Healthcare Value - Caring Wisely 2.0

Crowd-sourcing innovative cost savings ideas from the front lines of care delivery systems

Ordering Wisely at SFGH

In the course of busy workflow it is difficult for providers to integrate cost:benefit analysis while writing orders.  In order to provide meaningful clinical decision support to providers in order to change ordering behavior, we propose to create a list of the 10-15 most expensive diagnostic and/or therapeutic orders which have equivalently effective, evidence-based, more cost-conscious alternatives.  An example: ionized calcium (an expensive lab test), which could be safely replaced in many cases by a calcium and an albumin level (inexpensive tests) and simple math.  We propose to create our list via discussion with colleagues in lab medicine, radiology and pharmacy, and use of the existing Choosing Wisely guidelines as a starting point.  Our SFGH Ordering Wisely list would be integrated into practice via educational posters in resident workrooms, pocket cards, and ultimately via clinical decision support on SFGH's computer provider order entry (CPOE) system with pop-up messages when the costly alternative is selected, and a pathway for rapid conversion of the order to the more cost-effective alternative.

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