Background: As hospitals are increasingly reimbursed for value-based care, quality improvement projects addressing overutilization of routine “daily labs” have become commonplace. Although there are many published studies of daily labs reduction initiatives, there is little consensus on the actual costs of these routine labs to institutions, with most relying on Centers for Medicare & Medicaid Services cost data. Furthermore, there is large variation in literature; the cost for a complete blood count (CBC) ranges from $5 to $120, with some including labor cost and others omitting.
Purpose: The aim of this project was to develop an accurate method for cost analysis of CBC, basic metabolic panel (BMP), and complete metabolic panel (CMP) labs that captures the direct material and overhead costs, as well as the labor costs associated with drawing blood work daily at our institution.
Description: We created a comprehensive process map of the procedure for blood draws from the time a physician orders a routine lab test in the electronic medical record to when results are delivered (Figure). The process map was developed through interviews of patient care associates, nurses, and physicians on a 34-bed inpatient medicine unit, at an urban, tertiary academic medical center. Nursing labor cost of each blood draw was estimated by averaging the number of minutes per each step, estimated by interviewed staff. Nursing leadership approved the process map with the estimated times.
Conclusions: We determined that steps 8-12 (Figure) of the process map are direct labor costs incurred while drawing labs, and these were used to calculate the labor cost per lab. Steps 14b-17b involve nursing labor, however, urgent result phone calls to nurses for indicated tests are uncommon, and were excluded in the calculation of labor cost. Based on our process map, nurses dedicated an average of 20 minutes per test from when an order is sent to when results are posted. The labor cost was calculated based on a $95,000 average annual salary for registered nurses at our institution. Averaging a 37.5-hour week, nurses earn 81 cents per minute, and therefore 20 minutes of labor cost $16.24. The direct cost data was collected from the institution’s finance department and includes the costs of the materials and overhead of the laboratory department. The direct costs for CBC, BMP, and CMP labs are listed (Table). Based on our innovative process map method, we believe that our cost analysis provides a more accurate estimate of the costs of CBC, BMP, and CMP.
