Reducing Overuse of 3-Day Repeat Type and Screen Testing across an 11-Hospital Safety Net System.

From the 2023 HVPA National Conference

Da Wi Shin BE (Icahn School of Medicine at Mount Sinai), Daniel Alaiev BBA (New York City Health + Hospitals),  Surafel Tsega MD, Mona Krouss MD, Hyung Cho MD

Background:
According to the American Association of Blood Banks, a T&S is valid for up to three calendar days. Beyond a limited number of clinical indications such as a transfusion reaction, repeat T&S testing within three days is not warranted. Inappropriate repeat T&S testing is a costly medical waste and can lead to patient harm.

Objective:
To reduce inappropriate duplicate T&S testing across a large, multihospital setting

Setting:
The largest urban safety net health system in the United States, with 11 acute care hospitals.

Methods:
Our first intervention involved adding the time elapsed since the last T&S order into the order and the process instructions that described when a T&S was indicated. The second intervention was a best practice advisory (BPA) that triggered when T&S was ordered before the expiration of an active T&S. The primary outcome measure was the number of duplicate inpatient T&S per 1000 patient days.

Results:
Across all hospitals, the weekly average rate of duplicate T&S ordering decreased from 8.42 to 7.37 per 1000 patient days (12.5% reduction, p<0.001) after the first intervention and to 4.32 per 1000 patient days (48.7% reduction, p<0.001) after the second intervention. Using linear regression to compare pre-intervention to post-intervention 1, the level difference was -2.46 (9.17 to 6.70, p<0.001) and slope difference was 0.0001 (0.0282 to 0.0283, p=1). For post-intervention 1 to post-intervention 2, the level difference was -3.49 (8.06 to 4.58, p<0.001) and slope difference was -0.0428 (0.0283 to -0.0145, p<0.05).

Conclusions:
Our intervention successfully reduced duplicate T&S testing using a two-pronged EHR intervention. The success of this low effort intervention across a diverse health system provides a framework for similar interventions in various clinical settings.

Clinical Implications:
Clinically inappropriate repeat T&S testing represents a costly medical waste for the hospital system. Additionally, unnecessary blood draws may lead to patient harm such as pain and iatrogenic anemia. In safety net settings where healthcare is provided to medically underserved individuals who have limited access to healthcare resources due to socioeconomic, cultural, or geographic barriers, the impact of waste is particularly significant.

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