Background: Serum B-type natriuretic peptide (BNP) levels, measured on admission and discharge, have been a prudent predictor of outcomes among patients with heart failure. However, daily BNP measurements have no benefits for the management of heart failure and are costly. We investigated the practice pattern in St. Luke’s Hospital, and employed an educational intervention to improve the practice.
Methods: We retrospectively collected 3-month data on adult patients who were admitted in the hospital with CHF and on whom BNP was ordered. We documented the total number of BNP’s ordered in each patients during hospitalization. After completion of pre-intervention data collection, we implemented a 3-month educational intervention directed at hospitalists, PCPs, nurse practitioners and residents to reduce inappropriate ordering of BNP.
Results: During pre-intervention period 152 patients were admitted with CHF and 150 (99%) had BNP ordered at admission, 104 patients (68%) had BNP ordered at discharge, and a total of 428 BNPs were ordered during hospital stay. The total number of unnecessarily ordered BNPs (174) was calculated by subtracting the number of BNPs ordered at admission (150) and discharge (104) from the number of total BNP measurements (428). Forty percent (174/428) were unnecessarily ordered according to AHA guidelines. Based on BNP measurement costing $145, the cost associated with unnecessary BNP measurements in a 3-month period is about $25,230 and an annualized cost of approximately $100,000. Our post-intervention data collection is currently ongoing, but the preliminary data showed that the frequency of unnecessary BNP measurement dropped to zero in first month.
Conclusions: Our pre-intervention data demonstrated that 40% of BNPs ordered in hospitalized patients with CHF were unnecessary. The preliminary data after a 3-month educational intervention showed significant improvement in the practice pattern for ordering BNPs