Document Type

DNP Project


School of Nursing

Date of Degree

Spring 2019


Doctor of Nursing Practice (DNP)

Primary Advisor

Cathie E. Guzzetta, PhD, RN, FAAN; Eric Gehrie, MD, SM; Qiuping (Pearl) Zhou, PhD, RN


Background: Overuse of phlebotomy testing offers little to improve patient outcomes. Reducing unnecessary phlebotomy tests can cut costs without compromising quality.

Purpose: To determine the effectiveness of a clinical decision support system (CDSS) on reducing unnecessary type and screen tests, estimate the cost saved by the CDSS implementation, and describe the unnecessary ordering practices by provider type.

Methods: Our study used a separate-sample pretest posttest design at a mid-Atlantic academic medical center to examine the number of unnecessary type and screen tests three months before and after CDSS implementation. A CDSS was embedded in our electronic health record. The CDSS appears when a type and screen is ordered informing the provider of the date and time the current test expires. Cost savings was estimated using time-driven activity-based costing. Pre-intervention (801 tests) and post-intervention (801 tests) periods were used to describe ordering practices by provider type.

Results: There were a total of 26,206 pre- and 25,053 post-intervention specimens. Significantly fewer unnecessary type and screen tests were ordered after the intervention (12.3%, n=3,073) than before (14.1%, n=3,691; p<0.001). The results demonstrated an estimated yearly savings of $142,612 after CDSS implementation. The majority of the tests were ordered by physicians (85.3% before and 83.1% after the intervention) compared to advanced practice nurses and physician assistants.

Conclusions: Our study demonstrated that a CDSS impacted a variety of provider types, reduced unnecessary phlebotomy tests, and decrease annual costs. Interventions such as education, audits, and feedback are recommended to further reduce unnecessary ordering practices.

Open Access




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