BEDSIDE ASSESSMENT OF THE NECESSITY OF DAILY LAB TESTING FOR PATIENTS NEARING DISCHARGE

Surafel Tsega, MD*1;Michelle O'Connor2;Jashvant Poeran, MD, PhD3;Colin Thomas Iberti, MD1 and Hyung Cho, MD3, (1)Mount Sinai Hospital, New York, NY, (2)Icahn School of Medicine at Mount Sinai Hospital, New York, NY, (3)Icahn School of Medicine at Mount Sinai, New York, NY

Meeting: Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev.

Abstract number: 222

Categories: Innovations Abstracts, Quality Improvement

Keywords: , ,

Background : As part of the Choosing Wisely campaign, the Society of Hospital Medicine recommends against performing “repetitive complete blood count [CBC] and chemistry testing in the face of clinical and lab stability.” This recommendation stems from a body of research that shows that frequent or excessive phlebotomy can have negative consequences, including iatrogenic anemiaincreased cost, potentially unnecessary follow-up testing and treatment, and most importantly, nuisance and pain detrimental to a patient’s experience. 

Purpose : While no clear criteria or guidelines exist to define clinical stability in the context of lab utilization, we argue that patients planned for discharge within 24-48 hours are clinically stable and less likely to need lab testing. Using this framework, we implemented a multifaceted, patient-centered initiative—the Necessity of Labs Assessed Bedside Initiative (NO LABS)—that focuses on reducing lab testing in patients 24-48 hours before discharge. 

Description : We targeted two inpatient hospitalist units. Both employed bedside, patient-centered interdisciplinary rounds (with the hospitalist, social worker, case manager, nurse, nurse manager, and medical director), and followed a script highlighting the daily plan and patient safety issues. We incorporated a prompt to identify clinically stable patients for next-day discharge, and to consider discontinuing labs when appropriate. This intervention was coupled with education and a robust awareness campaign targeting reduction in unnecessary lab testing. In the 2,877 discharges included (baseline June 2014-June 2015; post-intervention July 2015-July 2016) there was a significant decrease in the percentage of patients with lab orders 24 hours prior to discharge (baseline mean 56.2%; post-intervention mean 44.4%). A similar trend was seen for labs ordered 48 hours prior to discharge (77.8% vs. 69.7%). This corresponded with a significantly decreasing trend in the percentage of patients getting labs in the 24, 48 and 72 hours before discharge after the intervention (-1.87%, -1.47%, and -0.74% decrease per month, respectively; P<0.05; Figure). 

Conclusions : Our patient-centered, multifaceted approach effectively reduced unnecessary daily labs. Bedside rounding and the emphasis on discontinuing lab testing provided a unique opportunity to effectively communicate to the patient about necessary (or unnecessary) testing. Moreover, given the complexity of identifying clinical stability, our strategy focused on the onset of discharge planning, a more easily discernible and less obtrusive focal point to consider discontinuation of lab testing. We believe that our structured, multidimensional, patient-centered intervention can provide a strong framework for decreasing unnecessary testing beyond the last 48 hours of admission.

To cite this abstract:

Tsega, S; O'Connor, M; Poeran, J; Iberti, CT; Cho, H . BEDSIDE ASSESSMENT OF THE NECESSITY OF DAILY LAB TESTING FOR PATIENTS NEARING DISCHARGE. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 222. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/bedside-assessment-of-the-necessity-of-daily-lab-testing-for-patients-nearing-discharge/. Accessed February 22, 2020.

« Back to Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev.