Identifying potential cost savings during inpatient stroke evaluation. 

Retrospective review of Epic electronic medical records of patients admitted with the diagnosis of cerebral infarction from January 1st, 2018 - January 1st, 2020. There were 6938 patients identified and 515 (7.42%) patients received at least one test. The two specific tests were - Hypercoagulable Panel (activated protein C resistance, protein C activity, protein S activity, and antithrombin III) and Homocystiene level. Medical records were individually reviewed for subsequent diagnosis of hypercoagulability. Data were evaluated to determine rates of administration using Python and Jupyter.

There were 473 Hypercoagulable panels sent at a cost of $571 each for a total of $270,083 and 287 Homocysteine levels sent at a cost of $174 each for a total of $49,938. The overall amount was $320,021. There were 350 (68%) individuals that had at least one abnormal test.

There is no one size fits all approach to stroke work up but avoiding tests that do not inform clinical decisions will reduce the unnecessary use of limited resources.  Our data suggest that implementing a quality improvement intervention such as an EHR alert when ordering tests could lead to a cost savings of hundreds of thousands of dollars per year.  Analysis on implementation and outcomes is ongoing.