Laboratory testing plays a central role in inpatient diagnosis and treatment of disease However, laboratory testing can contribute significantly to health care costs and may incur potential risks to patients, such as additional testing spurred by false positive test results. Additionally, up to 30‐60% of lab tests during an inpatient admission do not provide useful information. Resident physicians might be more prone to lab overutilization because of limited clinical experience and lack of formal education about appropriate lab ordering.
We are currently implementing a quality improvement project to decrease routine blood test ordering by internal medicine residents at the University of Washington (UW). Previously published interventions to decrease provider lab ordering have included provider education, direct provider feedback, and lab requisition modification. Utilization report cards have been shown to effectively decrease lab ordering in the outpatient setting. Furthermore, multifaceted interventions were more effective than uni‐ dimensional approaches, and resulted in longer lasting changes. We thus designed a two‐pronged intervention aimed at internal medicine resident physicians on the general inpatient medicine service at our two teaching hospitals. We hypothesized that the number of daily lab tests, blood transfusions, and electrolyte repletions ordered by inpatient residents who receive the intervention would decrease.
The intervention consists of a weekly “laboratory utilization report card” and a lab ordering factsheet. The weekly report card provides numerical and graphical information regarding each resident team’s ordering of common blood tests (basic metabolic panel, complete blood count, magnesium, phosphate); the report includes the utilization data of other internal medicine resident teams to allow residents to compare their ordering with other teams. The fact sheet is distributed at the beginning of the residents’ 4‐week rotation and contains evidence‐based information about lab costs, appropriate clinical indications for ordering common labs, and encouragement to order labs thoughtfully. The primary outcome of the study is the number of routine labs ordered by residents. Additional outcomes will be measured to monitor the safety of the intervention: in‐hospital mortality, 30‐day readmission rates, length of stay, and in‐hospital adverse events (cardiac arrests, seizures, acute kidney injury, and cardiac arrhythmias not present on admission). The intervention is designed to be run every other month in order to provide a control group of residents who will not receive the intervention.
We have designed a multidimensional intervention aimed at internal medicine residents to decrease the number of routine blood tests ordered on the general medicine service at our institution hospitals.
To cite this abstract:Sparks R, Chang A, Salskov A, Narayanan M, Wentworth K, Anawalt B, Baird G, Staiger T. Use of a Report Card and Educational Intervention to Influence Routine Lab Ordering by Housestaff. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 231. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/use-of-a-report-card-and-educational-intervention-to-influence-routine-lab-ordering-by-housestaff/. Accessed March 28, 2020.