A Multicenter Before-After Study on Reducing Unnecessary Diagnostics by Changing the Attitude of Caregivers: Protocol for the RODEO Project

Abstract

BackgroundAppropriate use of diagnostic laboratory tests is challenging, and estimates of 20% for overutilization and 45% for underutilization have been reported. Introducing effective and sustainable solutions to stimulate optimal use of laboratory testing in clinical practice is a challenge. A recent pilot study from our group, focusing on increasing the awareness about appropriate laboratory testing with the aim of changing the mindset of health care workers, has shown promising results. In this project, we aim to extend this multistep intervention to the internal medicine departments of 4 large Dutch hospitals. We aim to reduce unnecessary laboratory testing by 5%.ObjectiveOur primary objective is to determine the effect of our intervention on diagnostic laboratory test order volume. Our secondary objectives are to determine the effect of our intervention on laboratory expenditure and order volumes, expenditures for other diagnostic modalities, and clinical patient outcomes. We will also analyze the barriers and facilitators for deimplementation of unnecessary laboratory testing.MethodsThe main interventions of this before-after study will be an intensified supervision of residents by experienced physicians regarding test ordering, creating awareness through education and monthly feedback on ordering patterns, and changes in (computerized) order entry systems.ResultsAt the time of publication of this protocol, the project is in the phase of data collection. We expect to present data on reduction early in the fourth quarter of 2018.ConclusionsIn this project, we aim to reduce the unnecessary diagnostic testing in the internal medicine departments of 4 teaching hospitals. Although the main interventions will be similar, each clinic is given the opportunity to focus on the specific facets of the interventions as deemed useful according to the local situation. If effective, the study provides a framework for a nationwide initiative for reducing inappropriate laboratory testing.Registered Report IdentifierRR1-10.2106/10473

Association of a Multifaceted Intervention With Ordering of Unnecessary Laboratory Tests Among Caregivers in Internal Medicine Departments

“…The study protocol providing a detailed description of the methods has been published previously. 13 Therefore, we provide only a brief overview of the methods here.…”

“…Local ethics committees and boards of directors of all participating hospitals approved the study. 13…”

“…Facilitators and barriers were identified through questionnaires with the project teams 13 at initiation, during joint conferences, and through a questionnaire filled out by all physicians at participating departments at the end of the project (eAppendix 2 in the Supplement).…”

Is There Benefit in Keeping Early Discharge Patients Overnight After Total Joint Arthroplasty?

“…A goal for better health care is to reduce unnecessary care, waste, and harm to patients by improving clinical practices and deterring patients and providers from the belief that more is better [ 22 , 23 ]. Prior efforts to decrease expenditure by eliminating unnecessary health care modalities have proven to be effective in a variety of settings [ 24 , 25 ]. Whether TJA patients discharged on postoperative day 1 (POD 1) receive beneficial medical interventions the night of surgery, necessitating their stay in the hospital, remains unknown.…”

An audit of unnecessary preoperative urea and electrolyte panel tests in patients undergoing major orthopaedic surgery at a quaternary South African hospital

“…Unnecessary laboratory tests also place additional workloads on laboratory technologists, 7 and can lead to less patient-friendly practice. 8,9 Audits of preoperative laboratory testing at SA public-sector hospitals are scarce, and there is only one published SA study that has audited unnecessary preoperative laboratory test utilisation. 6 Given the potential implications for laboratory workloads, healthcare expenditure, and patient-friendly practice in the resourcelimited environment of the SA public healthcare sector, the objective of our study was to add to the sparse existing literature on this topic by conducting an audit of preoperative U&E panel requests in a sample of patients undergoing major orthopaedic surgery at a quaternary SA public-sector hospital.…”