D0484 - Reducing Inappropriate Serum Venous Ammonia Ordering: A Quality Improvement Initiative

William S. Reiche, DO¹, Bryce Schutte, DO¹, Suhail Sidhu, BS², Darby Keirns, BS², Durva Masih, MD¹, Isaac Burright, BS², Paul Millner, MD¹, Bradley DeVrieze, MD¹, Venkata Andukuri, MD¹, Sandeep Mukherjee, MD^1
1CHI Creighton University Medical Center, Omaha, NE; ²Creighton University School of Medicine, Omaha, NE

Introduction: Hepatic encephalopathy (HE) is a clinical diagnosis; however, ammonia levels are often ordered for diagnosing, staging, and assessing response to treatment in patients suspected of HE. Additionally, several large studies have found obtaining ammonia levels does not result in decreased length of stay, inpatient mortality, or lactulose volume used. Despite these studies and recommendations by the American Association for the Study of Liver Disease and the American College of Physicians to avoid ordering ammonia levels in patients with cirrhosis and chronic liver disease, the test is commonly ordered and contributes significantly to medical waste. We performed a bulletin board campaign to reduce inappropriate venous ammonia testing.

Methods: We prospectively evaluated the effect of a bulletin board campaign in reducing venous ammonia testing at CHI Creighton University Medical Center.

Results: Although not statistically significant across all departments, the intervention was associated with an overall 52% reduction in serum venous ammonia testing, and 75% reduction in internal medicine testing after the intervention (p = 0.191). Total potential savings for patients totaled more than $42,000.

Discussion: A bulletin board campaign directed predominantly toward emergency, internal, and family medicine was associated with a reduction in inappropriate serum venous ammonia testing. Our findings suggest serum venous ammonia testing is a significant contributor to medical waste. Future efforts to incorporate an electronic decision-making tool will likely allow for sustainable reduction in ammonia testing.




Disclosures:


William S. Reiche, DO¹, Bryce Schutte, DO¹, Suhail Sidhu, BS², Darby Keirns, BS², Durva Masih, MD¹, Isaac Burright, BS², Paul Millner, MD¹, Bradley DeVrieze, MD¹, Venkata Andukuri, MD¹, Sandeep Mukherjee, MD¹. D0484 - Reducing Inappropriate Serum Venous Ammonia Ordering: A Quality Improvement Initiative, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.