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A quality improvement project to reduce overutilization of blood tests in a teaching hospital.

ABSTRACT: Objective: In hospitals, physicians-in-training are major contributors to the burden of tests ordered, increasing cost and resource utilization. We implemented an intervention to discourage overutilization of the complete blood count (CBC) and the basic metabolic panel (BMP). Methods: An intervention was designed, comprising education on high-value care and burden of over-testing, encouragement of competition, and use of positive reinforcement. The intervention was monitored by a test index determined by dividing the total number of a specific laboratory test ordered for a patient by the total number of hospital days. Results: Following a 6-month intervention, the mean CBC index decreased from 1.56 ± 0.02 to 1.45 ± 0.03 (p < 0.001), and the BMP index, from 1.35 ± 0.02 to 1.14 ± 0.03 (p < 0.001). There was significant interaction between the intervention and the slope of the BMP index trend (p = 0.03), but not the CBC index trend. The intervention had no impact on hospital length of stay and mortality. Conclusion: This quality improvement intervention is an effective approach to reducing overutilization of laboratory tests.

SUBMITTER: Almeqdadi M

PROVIDER: S-EPMC6586109 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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A quality improvement project to reduce overutilization of blood tests in a teaching hospital.

Almeqdadi Mohammad M Nair Hari Krishnan HK Hill Jeoffrey J Sanchez-Cruz Julian J Nader Claudia C Jaber Bertrand L BL

Journal of community hospital internal medicine perspectives 20190619 3

<b>Objective</b>: In hospitals, physicians-in-training are major contributors to the burden of tests ordered, increasing cost and resource utilization. We implemented an intervention to discourage overutilization of the complete blood count (CBC) and the basic metabolic panel (BMP). <b>Methods</b>: An intervention was designed, comprising education on high-value care and burden of over-testing, encouragement of competition, and use of positive reinforcement. The intervention was monitored by a t ...[more]

PMID: 31258856

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Project description:BackgroundWe identified that Stanford Health Care had a significant number of patients who after discharge are found by the utilization review committee not to meet Center for Mediare and Medicaid Services (CMS) 2-midnight benchmark for inpatient status. Some of the charges incurred during the care of these patients are written-off and known as Medicare 1-day write-offs. This study which aims to evaluate the use of a Best Practice Alert (BPA) feature on the electronic medical record, EPIC, to ensure appropriate designation of a patient's hospitalization status as either inpatient or outpatient in accordance with Center for Medicare and Medicaid services (CMS) 2 midnight length of stay benchmark thereby reducing the number of associated write-offs.MethodWe incorporated a best practice alert (BPA) into the Epic Electronic Medical Record (EMR) that would prompt the discharging provider and the case manager to review the patients' inpatient designation prior to discharge and change the patient's designation to observation when deemed appropriate. Patients who met the inclusion criteria (Patients must have Medicare fee-for-service insurance, inpatient length of stay (LOS) less than 2 midnights, inpatient designation as hospitalization status at time of discharge, was hospitalized to an acute level of care and belonged to one of 37 listed hospital services at the time of signing of the discharge order) were randomized to have the BPA either silent or active over a three-month period from July 18, 2019, to October 18, 2019.ResultA total of 88 patients were included in this study: 40 in the control arm and 48 in the intervention arm. In the intervention arm, 8 (8/48, 16.7%) had an inpatient status designation despite potentially meeting Medicare guidelines for an observation stay, comparing to 23 patients (23/40, 57.5%) patients in the control group (p = 0.001). The estimated number of write-offs in the control arm was 17 (73.9%, out of 23 inpatient patients) while in the intervention arm was 1 (12.5%, out of 8 inpatient patient) after accounting for patients who may have met inpatient criteria for other reasons based on case manager note review.ConclusionThis is the first time to our knowledge that a BPA has been used in this manner to reduce the number of Medicare 1-day write-offs.

Dataset Information

A quality improvement project to reduce overutilization of blood tests in a teaching hospital.

Publications

A quality improvement project to reduce overutilization of blood tests in a teaching hospital.

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