Update

Six months prior, Quality of Care NL launched a campaign to lower the number of Blood Urea tests across Eastern Health. Efforts to curb potentially unnecessary tests have made a direct impact on patient care!

There is still work to do in reducing overtesting, but this is a great first step.

Here’s how the numbers break down…

Phase 2: Use of Blood Urea Test in General Practice

01 November 2016 – 30 April 2017

1. Blood urea is usually not necessary to assess stable kidney function because the e GFR is now available, but is often ordered together with serum creatinine.
2. Quality of Care NL, using a peer comparison program and academic detailing, attempted to uncouple the ordering of blood urea from s. creatinine.
3. During the Quality of Care NL Campaign, the ordering of blood urea was changed: physicians are now required to provide a written order for blood urea.
4. From Nov 1 2016 – Apr 30 2017 there was a significant drop in urea ordering. There were about 8000 fewer tests/month compared to the same period of time 2015-2016, a 46% drop compared to s. creatinine rates.
5. Your personal ordering of blood urea compared to your peers pre and post the intervention can be requested.

• Although blood urea provides a measure of kidney function, it is not necessary to evaluate stable kidney function.
• Serum creatinine and estimated GFR (eGFR) is sufficient to evaluate stable kidney function; if you order a serum creatinine for this purpose, a blood urea is not necessary.
• In acute kidney injury, blood urea may be useful to assess the cause. Urea that is disproportionately high compared to the rise in creatinine may be seen in conditions where there is volume depletion, hypercatabolism or bleeding into the upper GI tract.

Kidney Function Tests Ordered by Family Doctors

Blood Urea Tests Ordered by Family Doctors

• The number of urea tests dropped dramatically.
• On average 8,000 less tests were ordered per month compared to the same time the previous year.

Comparison of Top 20 Family Doctors by Volume of Blood Urea Tests

Nov 2015 – April 2016 and Nov 2016 – April 2017

Many physicians had significantly improved their blood urea ordering practices, but some were still among the most frequent orders.

Number of Kidney Function Tests by Month by Family Doctors

April 01, 2015 to April 30, 2017

Conclusion

A mutifaceted intervention resulted in 50% reduction of blood urea testing by family doctors.

Thank you for your efforts in reducing potentially unecessary tests!