Reducing Unnecessary Daily Laboratory Testing through House Staff Education on High Value Care

From the 2018 HVPAA National Conference

Vishnu Kommineni (University of Alabama at Birmingham), Sasya Dronavalli (University of Alabama at Birmingham), Richard Ivey (Huntsville Hospital), Parekha Yedla (University of Alabama at Birmingham)

Background

Aim: To evaluate and improve the house staff’s practice of ordering routine lab tests and to incorporate the principles of high value, cost-effective care.

Objectives

To evaluate and improve the house staff’s practice of ordering routine lab tests and to incorporate the principles of high value, cost-effective care.

Methods

Electronic medical records of the patients admitted to Internal medicine service for one random month (Group 1) were reviewed and data were abstracted on demographics, length of stay (LOS), readmissions, laboratory tests, and lab-free days. Patients with LOS > 20 days were excluded. In patients with more than 2 days of lab tests, development of clinically relevant changes in the Hemoglobin, WBC, platelets, creatinine, and electrolytes over the course of the hospital stay was identified using preset criteria (Table 1).

House staff and faculty were given feedback using the results from group 1. They were also educated on the core principles of high value care as defined by ACP and Choosing Wisely initiative with a focus on reducing unnecessary cost burden and discomfort to patients. House staff were frequently reminded through text messages, emails, handouts, and didactic presentations to reinforce these concepts. Subsequently, data as outlined above were extracted for another month (Group 2) and both the groups were compared.

Results

Mean number of BMP’s and CBC’s performed per patient per day were 1.229 and 1.164 respectively in Group 1 (n=273) as compared to 1.079 and 0.933 in Group 2 (n=217). (Table 2)

In Group 2, 43.78% of patients had lab-free days, which was significantly higher than Group 1 (31.5%).

Among patients with more than 2 days of lab tests, 53.5% in Group 1 (n=226) were noted to have clinically relevant changes in the BMP’s whereas in Group 2 (n=183), it was 64.4%.

Similarly, 47.7% of Group 1 (n=220) patients had clinically relevant changes in the CBC’s compared to Group 2 (n=164) where 59.1% of them were deemed clinically appropriate. (Table 3)

Conclusion

Conclusions:

A house staff led intervention utilizing education and data feedback was associated with significant reduction in daily lab testing rates.

Future Objectives:

•To promote principles of High value care among other academic and non-academic services in Huntsville Hospital.

•To continue education of House staff to practice cost effective care in other areas such as radiology, microbiology.

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