Improvement work isn’t easy, especially when it attempts to address rising health care costs. Solid organ transplant coordinator Sharon Ugolini and her team led award-winning work implementing new protocols for common tests. That led to more than just reduced patient charges, though — ordering appropriate tests increases value and quality, as well. Infection and bone marrow suppression are common complications our solid organ transplant patients experience. Even though we routinely monitor those complications, we’ve found a lot of system-wide inconsistencies related to the lab work involved. These inconsistencies can lead to repetitive blood draws, delayed results and care, increased patient charges due to multiple lab visits to collect missed or incorrect tests, and patient dissatisfaction. Our objective was to investigate whether the implementation of protocols standardizing lab order sets could result in reduced charges for solid organ transplant recipients.

1. Financial Impact of Testing Standardization for
Solid Organ Transplant Recipients
U G O L I N I , S . , M S N , R N ; D R A N O W, L . ; S A D L E R , P. ; B E R RY, M . , B S N , R N ; S T E H L I K , J . , M D ; D R A K O S , S . ,
M D ; N AT I V I , J . , M D ; G I L B E RT, E . M . , M D ; M C K E L L A R , S . , M D ; K O L I O P O U L O U , A . , M D ; Y I N , M . , M D ;
D AV I S , E . , B S N , R N ; S E L Z M A N , C . , M D ; W E V E R - P I N Z O N , O . , M D
Transplant Service Line, University of Utah Health and
Division of Cardiology, University of Utah School of Medicine, Salt Lake City, Utah

2. Background
 Infection and bone marrow suppression are common
complications after solid organ transplantation
 Routine blood testing is standard of care in transplant
recipients to help prevent these complications
 Ordering incorrect lab tests can lead to:
◦ Repetitive blood draws
◦ Delay in results and patient care
◦ Increased financial burden (multiple lab visits to collect missed or correct tests)
◦ Patient dissatisfaction

3. Objective
We sought to investigate whether the implementation of protocols
standardizing lab order sets and staff and patient education, would
result in more cost-effective patient care in solid organ transplant
recipients.
 Project started as one of
my FY17 SMART Value
Goals, aligning with the
University of Utah Health
Mission and Value Plan to
provide exceptional patient
experience while being
fiscally responsible

4. Plan: Identify
• ↑ transplant care cost
• Medications
• Procedures
• Testing
Do: Investigate
• Lack of ordering standardization
• Which lab is best?
• CBC vs. CBC w/ diff
• CMV vs. CMV-PCR
Check: Verify
• Less expensive testing clinically safe
• Reviewed heart transplant orders, found
inconsistences
• Translate heart findings to other organs
Act: Implement
• Created protocol for all organs
• Implemented in FY-17
• Educated staff & patients
• Assess & monitor

5. Methods: Protocol Design and Implementation
CBC W/ DIFF & CMV-PCR
WERE IDENTIFIED AS
MOST COST-EFFECTIVE
STANDARD TESTS
1. Minimize ordering variability
• Created new, standardized lab order sets across all solid
organ groups with the most cost-effective tests – uploading
into EMR
2. Avoid erroneous or missing testing
• Implemented changes
• Educated patients and staff regarding changes
3. Monitor
• Met quarterly to review progress
• Compared the proportion of incorrect tests and associated
charges between the pre- and post-protocol era

6. Methods: Patients and Material
 Data collected from FY-16 and FY17
 Number of labs analyzed
 1,532 CMV tests collected
 n=692 tests drawn prior to implementation
 n=840 tests drawn after implementation
 11,231 CBC tests collected
 n=6,201 tests drawn prior to implementation
 n=5,030 tests drawn after implementation
 500 patients monitored

7. Results: Error Reduction and Cost Savings
CMV
Most significant change in liver transplant
cohort
Pre- vs. post-protocol: 33.5% vs. 1.2%, p<0.001
(resulted in savings)
CBC
 Most significant change in heart transplant
cohort
Pre- vs. post-protocol: 26.2% vs. 20.3%, p=0.04
(resulted in savings)

8. Conclusion
 Using Specific, Measured, Attainable, Realistic, and Timely (SMART)
goals strategy, we developed and implemented a standardized protocol of
post transplant lab surveillance across all solid organ transplant groups.
 Standardizing post-transplant testing in solid organ transplant recipients
resulted in reduced number of inappropriate tests and associated health
care charges.
 These standardized order sets are now smart sets in EMR.
 These changes could be translatable across other disciplines and
implemented in other facets of patient care. Further studies are
warranted.