ONE DAY AT A TIME: SUSTAINED CHANGES IN LABORATORY ORDERING PRACTICES ON HOSPITALIST SERVICES AT AN ACADEMIC MEDICAL CENTER

Dr. Allen B. Repp, MD, MSc*;Michael W. Latreille, MD;Maria Burnett, MD;Mark K. Fung, MD, PhD and Mark E. Pasanen, MD, University of Vermont Medical Center, Burlington, VT

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

Abstract number: 207

Categories: Quality Improvement, Research Abstracts

Background: Unnecessary laboratory (lab) testing contributes to excess health care expenditures and patient harm.  Multiple professional societies have recommended avoiding repetitive lab testing in the absence of clinical indications and some institutions have reduced lab utilization with improvement initiatives. However, repetitive lab testing remains a common practice at many hospitals. We conducted an initiative to change lab ordering practices at our academic medical center.

Methods:

Context: Internal Medicine and Family Medicine Hospitalist Services at the University of Vermont Medical Center.

Interventions: Education sessions with resident and attending physicians were conducted in January-March 2015. During these sessions, participants were asked to estimate the actual and desired rate of daily lab tests in hospitalized adults, educated about the risks of excessive phlebotomy, and encouraged to order lab tests one day at a time based on clinical questions. In April and November 2015, electronic lab orders were modified to promote ordering lab tests one day at a time. Starting in April 2015, periodic feedback about lab ordering was provided at the service level via e-mail.

Measures: The primary measure was the percentage of adult patients admitted and discharged from the hospitalist services who had any recurring daily order for common labs for >1 day. Secondary measures included the number of common lab tests per patient day.

Analyses: We used statistical process control techniques to compare post-intervention performance to the 15-month baseline performance period.

Results:

Resident and attending physicians (n=41) estimated that 85.3±19.0% of patients on their service had recurring daily lab tests and that 50.4±22.4% required daily lab tests. During the education phase, the mean percentage of patients with recurring daily lab orders decreased from 88% to 84% (P<0.01). With changes to the electronic orders, the mean percentage of patients with recurring daily lab orders decreased to 39% (P<0.01, Figure 1). The mean number of common lab tests per patient day decreased from 6.3 in the baseline period to 5.5 (P = 0.01) in the education period and to 4.4 (P<0.01) with changes to the electronic orders (Figure 2).

Conclusions:

Despite national recommendations to avoid unnecessary repetitive lab testing and local recognition of over-utilization of daily lab testing, educational interventions were associated with only small changes in lab ordering practices. Changes in electronic lab orders coupled with periodic feedback about lab ordering practices promoted marked and sustained changes in lab ordering practices. Re-configuration of electronic ordering systems can substantially influence lab ordering practices and may be required to support high-value practice patterns.

To cite this abstract:

Repp, AB; Latreille, MW; Burnett, M; Fung, MK; Pasanen, ME . ONE DAY AT A TIME: SUSTAINED CHANGES IN LABORATORY ORDERING PRACTICES ON HOSPITALIST SERVICES AT AN ACADEMIC MEDICAL CENTER. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 207. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/one-day-at-a-time-sustained-changes-in-laboratory-ordering-practices-on-hospitalist-services-at-an-academic-medical-center/. Accessed November 20, 2019.

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