A Multidisciplinary Housestaff-Led Initiative to Safely Reduce Daily Laboratory Testing

Abstract

A housestaff-led intervention utilizing education and data feedback with goal setting and peer comparison resulted in safe, significant reductions in daily laboratory testing rates.

Effect of Social Comparison Feedback on Laboratory Test Ordering for Hospitalized Patients: A Randomized Controlled Trial

“…Previous studies of SCF interventions to change physician behavior were designed to ensure feedback was delivered through in-person interactions 6 or did not measure the level of participant engagement with the feedback. 20,25 In our study, only about two thirds of participants in the intervention group accessed feedback via e-mail and fewer than one in five accessed the EMR-based dashboard. Another possibility is that physicians were already receiving feedback or were otherwise aware of their ordering patterns compared to their peers.…”

“…19 Previous studies of the effect of SCF on physicians' laboratory test-ordering behaviors showed some reduction in ordering. 3,6,20 However, those studies either used labor-intensive manual chart audit and in-person feedback from peers 6 or combined SCF with other resource-intensive interventions such as provider education. 20 With increased use of EMRbased dashboards by healthcare systems, 19 automated SCF alone represents an easily scalable intervention to influence frontline providers' treatment patterns.…”

“…3,6,20 However, those studies either used labor-intensive manual chart audit and in-person feedback from peers 6 or combined SCF with other resource-intensive interventions such as provider education. 20 With increased use of EMRbased dashboards by healthcare systems, 19 automated SCF alone represents an easily scalable intervention to influence frontline providers' treatment patterns. In this study, we incorporated SCF into a personalized, EMR-based, real-time utilization dashboard that was combined with a simple summary statement delivered via e-mail to internal medicine physicians in training (residents).…”

Interactive value‐based curriculum: a pilot study

“…When ascending Miller's pyramid to ‘knows how’, ‘shows how’ and ‘does’, studies become more limited. Recent studies have assessed trainees at the top of Miller's pyramid (‘does’), examining changes in ordering practices and cost following VBC interventions; however, assessment at the ‘does’ level does not isolate trainees’ decision making from factors affecting actual orders, such as the attending physicians’ practices. Assessment at the ‘knows how’ level, assessing the application of knowledge, is therefore important to understanding the extent to which residents understand and can apply the principles of VBC.…”

Response to ‘Choosing Wisely should bring the cost of unnecessary care back into the discussion’; Choosing Wisely’: a growing international campaign

“…Such implementation efforts can lead to cost savings or the redirection of dollars to other areas of clinical need. This is not unique to Canada, and there is a growing body of literature detailing successful implementation efforts associated with Choosing Wisely recommendations that have reduced unnecessary laboratory tests and blood transfusions, for example6 7 …”