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Original contribution| Volume 8, ISSUE 1, P1-13, January 1990

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Use of a mildly restrictive administrative protocol to reduce orders for manual blood film examination from the emergency department

DOI:https://doi.org/10.1016/0736-4679(90)90379-A
Use of a mildly restrictive administrative protocol to reduce orders for manual blood film examination from the emergency department
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      Abstract

      In order to conserve laboratory resources, we instituted a mildly restrictive administrative protocol requiring a telephone request by emergency physicians or their designees in order to obtain a manual blood film examination (BFE). This test includes a manual differential leukocyte count (DLC), examination of red cell morphology, and platelet estimate. The protocol resulted in a marked reduction of the number of BFE's performed on emergency department patients from the previous level of one for every complete blood count (CBC). Retrospective chart review of a sample of patients not receiving manual BFEs indicated no apparent adverse effect on patient care. We speculate that the availability of an electronic partial differential count, providing enumeration of lymphocytes and neutrophils along with the CBC, facilitated in part the reduced ordering of manual BFEs.

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      References

        • Shapiro M.F.
        • Greenfield S.
        The complete blood count and leukocyte differential count. An approach to their rational application.
        Ann Intern Med. 1987; 106: 65-74
        • College of American Pathologists
        1989 edition. Manual for Laboratory Workload Recording. College of American Pathologists, Skokie, IL1988: 90
        • Altman P.L.
        • Dittmer D.S.
        Blood and other body fluids.
        in: Federation of American Societies for Experimental Biology, Washington1961: 125
        • Wintrobe M.M.
        • Lee G.R.
        • Boggs D.R.
        • et al.
        Clinical hematology.
        in: 7th ed. Lea & Febiger, Philadelphia1974: 1794
        • Griswold D.J.
        • Champagne V.D.
        Evaluation of the Coulter SPlus IV three-part differential in an acute care hospital.
        Am J Clin Pathol. 1985; 84: 49-57
        • Cornbleet J.
        • Kessinger S.
        Evaluation of Coulter S-Plus threepart differential in populations with a high prevalence of abnormalities.
        Am J Clin Pathol. 1985; 84: 620-626
        • Nelson L.
        • Charache S.
        • Keyser E.
        • Metzger P.
        Laboratory evaluation of the Coulter “Three-part electronic differential”.
        Am J Clin Pathol. 1985; 83: 547-554
        • Allen J.K.
        • Batjer J.D.
        Evaluation of an automated method for leukocyte differential counts based on electronic volume analysis.
        Arch Pathol Lab Med. 1985; 109: 534-539
        • Cox C.J.
        • Haberman T.M.
        • Payne B.A.
        • Klee G.G.
        • Pierre R.V.
        Evaluation of the Coulter counter model S-Plus IV.
        Am J Clin Patho1. 1985; 84: 297-306
        • Snedecor G.W.
        • Cochran W.G.
        Statistical methods.
        in: 6th ed. Iowa State University Press, Ames, IA1967: 238-240
        • Connelly D.P.
        • McClain M.P.
        • Crowson T.W.
        • Benson E.X.
        The use of the differential leukocyte count for inpatient casefinding.
        Hum Pathol. 1982; 13: 294-300
        • Shapiro M.F.
        • Hatch R.L.
        • Greenfield S.
        Cost containment and labor-intensive tests. The case of the leukocyte differential count.
        JAMA. 1984; 252: 231-234
        • Rich E.C.
        • Crowson T.W.
        • Connelly D.P.
        Effectiveness of differential leukocyte count in case finding in the ambulatory care setting.
        JAMA. 1983; 249: 633-666
        • Kaplan E.B.
        • Sheiner L.B.
        • Boeckmann A.J.
        • et al.
        The usefulness of preoperative laboratory screening.
        JAMA. 1985; 253: 3576-3581
        • Morens D.M.
        WBC count and differential. Value in predicting bacterial diseases in children.
        Am J Dis Child. 1979; 133: 25-27
        • Stein R.C.
        The White blood cell count in fevers of unknown origin.
        Am J Dis Child. 1972; 124: 60-63
        • Rasmussen N.H.
        • Rasmussen L.N.
        Predictive value of white blood cell count and differential cell count to bacterial infections in children.
        Acta Paediatr Scand. 1982; 71: 775-778
        • Marchand A.
        • Van Lente F.
        • Galen R.S.
        The assessment of laboratory tests in the diagnosis of acute appendicitis.
        Am J Clin Pathol. 1983; 80: 369-374
        • Patrick G.L.
        • Steward R.J.
        • Isbister W.H.
        Patients with acute abdominal pain: white cell and neutrophil counts as predictors of the surgical acute abdomen.
        NZ Med J. 1985; 98: 324-326
        • Wenz B.
        • Gennis P.
        • Canova C.
        • Burn E.R.
        The clinical utility of the leukocyte differential in emergency medicine.
        Am J Clin Pathol. 1986; 86: 298-303
        • Callaham M.
        Inaccuracy and expense of the leukocyte count in making urgent clinical decisions.
        Ann Emerg Med. 1986; 15: 774-781
        • Eisenberg J.M.
        • Williams S.V.
        Cost containment and changing physicians' practice behavior. Can the fox learn to guard the chicken coop?.
        JAMA. 1981; 246: 2195-2201
        • Martin A.R.
        • Wolf M.A.
        • Thibodeau L.A.
        • Dzau V.
        • Braumwald E.
        The trial of two strategies to modify the test-ordering behavior of medical residents.
        N Engl J Med. 1980; 303: 1330-1336
        • Griner P.F.
        • Medical Housestaff, Strong Memorial Hospital
        Use of laboratory tests in a teaching hospital: long-term trends. Reductions in use and relative cost.
        Ann Intern Med. 1979; 90: 243-248
        • Eisenberg J.M.
        An educational program to modify laboratory use by house staff.
        J. Med Edu. 1977; 52: 78-81
        • Charache S.
        • Nelson L.
        • Keyser E.
        • Metzger P.
        A clinical trial of the three-part electronic differential white blood cell counts.
        Arch Intern Med. 1985; 145: 1852-1855
        • Li F.P.
        • Danahy J.
        • Gelman R.
        Utility of differential leukocyte counts in cancer management.
        JAMA. 1984; 252: 1312-1314

      Article info

      Publication history

      Accepted: April 11, 1989
      Received in revised form: March 6, 1989
      Received: August 23, 1988

      Identification

      DOI: https://doi.org/10.1016/0736-4679(90)90379-A

      Copyright

      © 1990 Published by Elsevier Inc.

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