From the 2018 HVPAA National Conference
Scott Sussman (Yale New Haven Health System), David Hajdasz (Yale New Haven Health System)
Routine labs, which include CBC and BMP or CMP are commonly over utilized, especially in the inpatient setting where they tend to be ordered daily without compelling clinical reasoning. Choosing Wisely recommends mindful ordering. It has been suggested that 10 days of routine labs phlebotomizes 1 unit of blood.
To improve mindful ordering of labs for hospitalized patients.
We provided educational sessions to the hospitalists in June 2016. We analyzed the rate of daily lab orders as well as the volume of blood saved per 1000 patient days over time for hospitalists.
We created a dashboard that we discussed at monthly meetings, and as part of a weekly e-mail to the team included the names of the providers who ordered “most wisely” during the previous week. To engage providers we included a metric about how much blood was saved each week, by giving patients lab holidays.
We tracked weekly CBC and BMP/CMP orders normalized to patient days from 12/28/2014 to 7/1/2017. A trend towards decreased daily lab orders existed both pre- and post-intervention. Regression analysis revealed that both time and intervention significantly decreased the level but not the trend of these daily labs.
An unintended consequence of daytime providers mindful routine lab ordering resulted in increased requests to place routine orders at night. To improve communication between shifts, we created a “No Labs Needed” which was used nearly 8,000 times between April 2015 and July 2017.
Reminding providers to “think before they click” and celebrating restraint in lab ordering allowed patients to keep hundreds of liters of their own blood, without any known adverse impact on patient care.
Implications for the Patient
Mindful laboratory ordering reduces waste (time, iatrogenic anemia, materials), and improves patient experience.