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The rise and fall of C-reactive protein: managing demand within clinical biochemistry

Background Managing workload within the laboratory has become a key role for clinical biochemists. National benchmarking data highlighted a 31% increase in C-reactive protein (CRP) requests between 2003–2004 and 2004–2005 for the University Hospital of North Staffordshire (UHNS). The aim of this study was to examine CRP requesting patterns within the acute admissions units. Methods Current requesting patterns within the Accident and Emergency Department (A&E) and Medical Admissions Unit (MAU) were audited. Following discussion with clinical colleagues, the laboratory implemented agreed disease-related protocols and consultant only requesting. The impact these demand management strategies had on requesting within these units was then assessed. Results The initial data (January–June 2005) showed that the average number of requests for CRP was 918 per month from A&E and 545 per month for MAU. Implementation of demand-management strategies resulted in an overall reduction of 85% in the numbers of requests, saving the Trust approximately £10,000 per annum. Further to the initial protocols, an IT-based logic rule was also developed to reduce CRP requests made within a 24 h time window of an initial request and educate users. Conclusion This study has demonstrated that strategies to control demand at the requesting stage have been able to reduce the number of requests from acute admission units. This study forms the basis for ongoing work on inappropriate requesting and illustrates that the introduction of agreed protocols in acute settings can be used as a demand-management tool.