The assays themselves are more expensive up front, but one of the value based care exercises we performed as CRQS shows the up front cost is outweighed by a huge ROI on information returned/NNT since electrolyte disturbances aren’t necessarily always hypothesis driven tests.
Magnesium and phosphate disorders are less common in acute settings and are often measured separately if there’s a clinical indication. Also, including additional tests like Mg and PO4 increases both the cost and complexity of the panel. All about balancing clinical usefulness with practicality
Electrolyte imbalances beget other electrolyte imbalances. Refeeding syndromes or persistent hypoK due to hypoMg are exceedingly common conditions in the acute care setting.
From a QI/value based standpoint, it saves money/improves diagnostic accuracy in the long run vs ordering separate tests.
Diagnostic accuracy doesn’t necessarily improve just by adding more tests. In fact, unnecessary tests can lead to false positives or result in clinicians over-interpreting isolated findings that are clinically insignificant in asymptomatic patients.
The principle of “less is more” applies here. Focusing on the most relevant clinical factors and ordering tests as needed can often be more effective than expanding routine panels and thus avoiding ‘test fatigue’
There’s absolutely an argument to be made about utility of chasing electrolytes and replacing them to arbitrary levels.
But there isn’t a good one against including two electrolytes commonly ordered separately when you look at the clinical ROI vs a test that would cost less overall if included.
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From a QI/value based standpoint, it saves money/improves diagnostic accuracy in the long run vs ordering separate tests.
Imbalances are insidious and the benefit to knowing a level is low can be the difference between preventing torsades or getting somebody off the vent
But there are plenty of asymptomatic patients with a K of 6.8, a phos of 0.7 or a Mg of 0.5 until they’re not.
If anything going out of my way to order what I consider routine lytes is more fatiguing.
But there isn’t a good one against including two electrolytes commonly ordered separately when you look at the clinical ROI vs a test that would cost less overall if included.