Rational use of blood calcium determinations

CONTEXT AND OBJECTIVE:This study was motivated by the recent excessive increase in requests for blood calcium determinations and laboratory tests in general, in the Hospital das Clínicas complex of Faculdade de Medicina, Universidade de São Paulo (HCFMUSP). Its aim was to suggest rules for the determination of total and ionized calcium in our intensive care units, emergency department, wards and outpatient services, thus contributing towards improving the quality of medical care and achieving more appropriate use of human and financial resources.DESIGN AND SETTING:Critical analysis on clinical and laboratory data and the pertinent scientific literature, conducted by the study group for rational clinical laboratory use, which is part of the Central Laboratory Division, HCFMUSP.METHODS:The study group reviewed scientific publications, statistics and clinical and laboratory data concerning requests for total and ionized calcium determinations in the settings of intensive care units, emergency department, wards and outpatient services.RESULTS:From this critical analysis, clinical decision flow diagrams aimed at providing guidance for ordering these tests were constructed.CONCLUSIONS:Use of the proposed flow diagrams may help to limit the numbers of inappropriate requests for ionized and total calcium determinations, with consequent reductions in the number of tests, risks to patients and unnecessary costs.

研究背景与目的：本研究的动因，为圣保罗大学医学院临床医院综合体（Hospital das Clínicas complex of Faculdade de Medicina, Universidade de São Paulo，HCFMUSP）近期血钙检测及各类实验室检验申请量的过度增长。本研究旨在为本院重症监护病房、急诊科、普通病房及门诊科室制定总钙与离子钙检测的合理应用规范，以期提升医疗服务质量，并实现人力资源与财力资源的更优化配置。
研究设计与实施场景：本研究由HCFMUSP中心实验室下属的临床实验室合理使用研究小组开展，通过对临床与实验室数据及相关科学文献进行批判性分析完成。
研究方法：该研究小组针对重症监护病房、急诊科、普通病房及门诊科室的总钙与离子钙检测申请情况，回顾梳理了相关科学文献、统计数据及临床与实验室资料。
研究结果：通过本次批判性分析，本研究构建了用于指导上述检验项目申请的临床决策流程图。
研究结论：采用本研究提出的决策流程图，可有效限制离子钙与总钙检测的不合理申请量，进而减少检验项目总量、降低患者诊疗风险与不必要的医疗成本。