REDUCING UNNECESSARY LABORATORY DRAWS ON INTERNAL MEDICINE WARDS: A QUALITY IMPROVEMENT PROJECT

From the 2019 HVPAA National Conference

Dr. Simon Pinsky (University of Texas Medical Branch), Dr. Judy Trieu (University of Texas Medical Branch), Dr. Sam Haslam (University of Texas Medical Branch), Dr. Farah Abifaraj (University of Texas Medical Branch), Dr. Yamam Al-saadi (University of Texas Medical Branch), Dr. Josh Gavin (University of Texas Medical Branch), Dr. Michael Hoffman (University of Texas Medical Branch), Dr. Abraham Lee (University of Texas Medical Branch), Dr. Chris Perez (University of Texas Medical Branch), Dr. Sharon Ogidan (University of Texas Medical Branch), Dr. Anjani Pandya (University of Texas Medical Branch), Dr. Jaspreet Sandhu (University of Texas Medical Branch), Dr. Nicole Sheung (University of Texas Medical Branch), Dr. Mathuran Sundaramoorthy (University of Texas Medical Branch), Dr. Tyler Tatsch (University of Texas Medical Branch), Dr. Lindsay Sonstein (University of Texas Medical Branch)

Background

Over-utilization of laboratory testing has been criticized for contributing to rising healthcare costs to causing iatrogenic anemia in hospitalized patients. Frequent blood draws are a nuisance to patients and healthcare staff, and as such, hospitals across the US are aiming to reduce lab over utilization.

Objective

The aim of our study was to quantify the number of blood draws per patient per day and reduce them 25% over a period of 3 months.

Methods

Patients admitted to the four general medicine floors at UTMB during June 1, 2018 to August 31, 2018 were included in the baseline data. Reasons for lab draws were identified among a randomized sample of patients from each floor. A multi-pronged approach was instituted: educating house staff, changes to UTMB EMR (EPIC), implementing a phlebotomy policy, sharing specimen across lab divisions, and incentivizing lab stewardship among house staff. Post-intervention data was collected from December 1, 2018 to February 28, 2019.

Results

Baseline data revealed an estimated 1.7 lab draws were performed per patient per hospital day, excluding those drawn due to acuity of care (e.g. decompensating patient). The most common reasons for labs draws included daily lab orders, consultant recommendations, and additional orders post-rounding. Post implementation, labs draws decreased to an average of 0.97 lab draws per patient per day across four internal medicine units at UTMB, with 42.9% overall reduction. Lab draws on the unit with the phlebotomy policy had a reduction of 59%.

Discussion

Overuse of labs has become a systematic problem amongst U.S. hospitals. After three interventions, our approach showed a 42.9% decrease in the number of lab draws during a 3-month follow up period. Introduction of the new phlebotomy policy showed an even greater reduction in labs being drawn without reported unintended adverse effects. Further plans to implement the above interventions are anticipated with a focus on education re-enforcement and novel lab throughput. Institutional lab utilization will need to be intermittently re-assessed in an effort to improve quality of care and reduce overall costs.

Clinical Implications

Lab draws pose risks and discomfort to patients, including local irritation and infection. Reducing unnecessary lab draws not only improves patient quality of care and the burden on nursing staff, but also decreases the costs associated with drawing and processing labs.

Figures

What are academic medical centers across the country doing to improve healthcare value?

Value improvement guides: Published reviews in JAMA Internal Medicine coauthored by experienced faculty from multiple leading medical centers, with safety outcomes data and an implementation blue print.

Review article detailing 25 labs to refine for high value quality improvement | July 2020

MAVEN campaign: Free 4 year high value care curriculum online.

Join the Alliance! Membership is free with institutional approval and commitment to improving value in your medical center.

Learn more about HVPAA on Health Affairs Blog