A Housestaff-Led Initiative to Reduce Laboratory Utilization at a Large Academic Center

From the 2018 HVPAA National Conference

Kevin Eaton (Johns Hopkins School of Medicine), Gigi Liu (Johns Hopkins Hospital), Sara Keller (Johns Hopkins Hospital)

Background

Ordering daily laboratory tests on patients with clinical stability has led to wasteful testing. This has resulted in unnecessary phlebotomy sticks for hospitalized patients. Unnecessary labs and multiple sticks can lead to hospital acquired anemia and decreased patient satisfaction. The entire lab collection process has become burdened by unnecessary volume.

Objectives

To reduce the number of phlebotomy sticks per patient per day by at least 25% by the end of June 2017 within the Department of Medicine.

Methods

After a cultural assessment of barriers to reducing lab ordering, two different interventions were developed. First, resident teams incorporated a review of labs ordered for each patient during rounds or sign out each day. Second, the phlebotomy charge lead notified on call residents when phlebotomy was arriving to their floors to begin lab collections. The interventions were run on two of the four general medicine firms from April to June of 2017. The number of phlebotomy sticks per patient per day was calculated before and after the interventions. Other outcome metrics included total number of lab orders and total number of STAT orders over time.

Results

The average number of phlebotomy sticks per patient before the interventions was 1.72. The average number of sticks during the intervention was not significantly changed at 1.67. The total number of lab orders and STAT orders were not significantly changed during the intervention.

Conclusion

Assessing the cultural dynamics of a department before designing interventions to address laboratory reduction is important. Overall, the culture in the Department of Medicine has shifted toward a more general awareness of laboratory over-utilization although the data suggest minimal improvement in our objective outcomes. A multimodal strategy should be adopted in order to have a more sustainable impact.

Implications for the Patient

A reduction in laboratory tests will improve the efficiency of an already overburden lab collection system. Fewer phlebotomy sticks will lead to improved patient satisfaction.