A new study reported that physicians at Johns Hopkins, along with experts from several other institutions across North America, compiled published evidence and crafted an experience-based quality improvement blueprint to reduce repetitive lab testing for hospitalized patients. The findings published in JAMA Internal Medicine.
Repeated blood draws for such tests can lead to hospital-acquired anaemia and other complications. This is the second paper co-authored by residents and faculty from the High-Value Practice Academic Alliance, a consortium of nearly 90 academic medical centres collaborating to improve health care quality and safety by reducing unnecessary components of practice that do not add value to patient care.
Excessive blood draws can deplete a patient's haemoglobin count, which often leads to repeat testing. The researchers have estimated that nearly 20% of hospitalized patients can develop moderate to severe hospital-acquired anaemia. The team asserts this spiral can generate additional unnecessary tests, interventions and costs for the patient.
Moreover, say the authors, the studies show that decreasing repetitive daily laboratory testing did not result in missed diagnoses or increase the number of readmissions to the hospital. Citing individual studies where front-line health care workers reduced the number of orders for lab tests by anywhere between 8% and 19%, the authors reported that cost savings have ranged from $600,000 to more than $2 million per year.
While many professional societies have recommended reducing repetitive lab tests, recommendations alone typically do not change behaviour. The most successful efforts to reduce daily lab testing in this review included a combination of educating health care providers about charges, obtaining feedback by showing providers' ordering habits and changing clinical workflow to restrict automated repeat ordering of tests.
The recommendations are designed hospital-wide educational initiatives backed by data to collectively outline and standardize best practice, establish target numbers by which to reduce lab test ordering and provide instant feedback to those ordering tests to show their personal ordering patterns, so they are aware of their own behaviour with respect to agreed-upon standards.
Reprogram the electronic systems used to order tests to restrict the number of "pre-ordered" tests with an eye on having better reasons to order tests than just doing so daily is also a recommendation. Reducing unnecessary daily inpatient laboratory testing is only one small improvement.
However, doing so successfully can help change the culture of health care providers to be more keenly focused on thoughtful ordering and prescribing for their patients. Improving patient safety and patient outcomes are the goals of the study, and an additional benefit to reducing the number of unnecessary diagnostics is also a reduction in the financial burden to the patient, researchers report.