Amit Pahwa (Johns Hopkins School of Medicine), Kevin Eaton (Johns Hopkins School of Medicine), Sara Keller (Johns Hopkins Hospital), Lenny Feldman (Johns Hopkins Hospital)
Frequent labs of hospitalized patients often do not change management and can lead to increased hospital acquired anemia and mortality. Physician peer comparison in some studies has lead to decreased inappropriate testing and treatment.
Decreasing sticks per patient per day and orders per patient per day by providing an electronic report of lab utilization data to internal medicine residents.
At this academic medical center, residents are assigned to four different firms for general medicine wards. Residents only rotate on their assigned firm and do not crossover. Two firms (randomly selected) will have access to a provider-level dashboard which will allow interns (PGY1) to follow their own diagnostic test utilization for half of the academic year. They will then have access taken away and access will be given to the other two firms for the remainder of the academic year. (AY2018)
Interns in the intervention group will receive their data every 2 weeks by email. Data will include sticks per patient per day, orders per patient per day, and volume of blood per patient per day. In addition to their own values, interns will be provided with averages compared to their peers. Data which is below the average will be displayed as red and data above average will be displayed as green. Along withe normalized data, interns will receive total numbers of sticks, order, and volume of blood. From the email interns can enter the portal for the dashboard which allows for further visualization of their utilization data.
This data was also be compiled and sent to the interns’ supervising resident and attending.
Interim analysis of July – September 2017 shows that for the primary outcome of sticks per patient per day the control group had 1.67 and the intervention group had 1.66. Only 1 resident entered the portal for the dashboard.
While an early analysis, a laboratory utilization dashboard using peer comparison data does not affect overall sticks per patient per day. Intern engagement with the dashboard may be low although hard to determine as interns may have only looked at their emails. Drivers of overtesting in the inpatient environment are multifactorial and may not be affected by peer comparison. More information will be available once the study is complete in July 2018.
Implications for the Patient
Reducing inappropriate labs in hospitalized patients can decrease risk of hospital acquired anemia and mortality but dashboards may not be effective for that purpose.