Could a Simple Best-Practice Advisory in the Electronic Health Record Reduce Blood Test Ordering?

In early 2021, healthcare institutions saw a nationwide shortage of sodium citrate (blue-top) tubes, used to collect blood for coagulation testing. Quality-improvement personnel at an academic hospital in Michigan implemented a best-practice advisory into the electronic health record (EHR) on May 15, 2021, for adult patients who presented to the emergency department or were hospitalized. When clinicians ordered prothrombin time (PT), international normalized ratio (INR), or partial thromboplastin time (PTT) blood tests, the EHR displayed the following message: “There is a national shortage on blue top tubes, and we request thoughtful restraint in reflexive ordering of PT/INR/PTT. Does this patient require PT/INR/PTT measurement?” The messag…