School of Medicine and Health Sciences Poster Presentations

Title

Reducing Unnecessary Inpatient Laboratory Testing

Document Type

Poster

Abstract Category

Quality Improvement

Keywords

labs, tests

Publication Date

Spring 5-1-2019

Abstract

Excessive laboratory testing is one of many areas of waste that plague the healthcare system. Morning laboratory tests for hospitalized patients are often ordered out of routine more than due to clinical indications that may affect medical management. The aim of our project was to reduce unnecessary morning laboratory testing on a medicine inpatient service by 15% from baseline. We identified six laboratory tests that are routinely drawn on hospitalized patients (CBC, differential, BMP, LFTs, magnesium level and phosphorus level). Tests were tracked via chart review on an internal medicine resident team at a large university urban hospital over a 4-week period. We gathered baseline data prior to any interventions. The first PDSA cycle involved discussing patient-centered harms of frequent blood draws and the financial cost of individual tests. We then posted an information sheet covering these points in the team workroom. The second PDSA cycle involved distributing a test checklist for the team to go through together for each patient during daily rounds. The first PDSA cycle was well received by the residents and the information sheet remained posted in the workroom throughout the duration of the project. Average tests per patient per day decreased from 2.5 to 2.2 (decrease of 12%) following this intervention. The second PDSA cycle coincided with the rotation of new interns onto the team. Copies of the test checklist template were distributed at different times to the team attending and the senior resident, however it was not put into practice due to miscommunication of its purpose and time constraints. Average tests per patient per day remained unchanged at 2.2 following this intervention. Although the project did not meet the aim of a 15% reduction in routine morning laboratory testing, the teaching session and information sheet used in PDSA cycle #1 did prove effective in sustaining a reduction over several weeks. This is a promising intervention as it can be implemented across multiple teams at minimal cost of time and resources. The test checklist in PDSA cycle #2 was not successfully implemented on the team. It may still be an effective intervention in reducing unnecessary testing, but requires commitment from medical teams that are already limited on time. Better explaining the purpose of the checklist and promoting attending and resident interest at an earlier point may improve the value of this intervention. Reducing unnecessary laboratory testing remains an important area of quality improvement focus.

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Presented at Research Days 2019.

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Reducing Unnecessary Inpatient Laboratory Testing

Excessive laboratory testing is one of many areas of waste that plague the healthcare system. Morning laboratory tests for hospitalized patients are often ordered out of routine more than due to clinical indications that may affect medical management. The aim of our project was to reduce unnecessary morning laboratory testing on a medicine inpatient service by 15% from baseline. We identified six laboratory tests that are routinely drawn on hospitalized patients (CBC, differential, BMP, LFTs, magnesium level and phosphorus level). Tests were tracked via chart review on an internal medicine resident team at a large university urban hospital over a 4-week period. We gathered baseline data prior to any interventions. The first PDSA cycle involved discussing patient-centered harms of frequent blood draws and the financial cost of individual tests. We then posted an information sheet covering these points in the team workroom. The second PDSA cycle involved distributing a test checklist for the team to go through together for each patient during daily rounds. The first PDSA cycle was well received by the residents and the information sheet remained posted in the workroom throughout the duration of the project. Average tests per patient per day decreased from 2.5 to 2.2 (decrease of 12%) following this intervention. The second PDSA cycle coincided with the rotation of new interns onto the team. Copies of the test checklist template were distributed at different times to the team attending and the senior resident, however it was not put into practice due to miscommunication of its purpose and time constraints. Average tests per patient per day remained unchanged at 2.2 following this intervention. Although the project did not meet the aim of a 15% reduction in routine morning laboratory testing, the teaching session and information sheet used in PDSA cycle #1 did prove effective in sustaining a reduction over several weeks. This is a promising intervention as it can be implemented across multiple teams at minimal cost of time and resources. The test checklist in PDSA cycle #2 was not successfully implemented on the team. It may still be an effective intervention in reducing unnecessary testing, but requires commitment from medical teams that are already limited on time. Better explaining the purpose of the checklist and promoting attending and resident interest at an earlier point may improve the value of this intervention. Reducing unnecessary laboratory testing remains an important area of quality improvement focus.