High-Value, Cost-Conscious Care: Iterative Systems-Based Interventions to Reduce Unnecessary Laboratory Testing

Decreasing daily blood work in hospitals: What works and what doesn't

“…Many interventions are multifaceted incorporating both a component of person‐oriented intervention as well as change in system design or process. Table lists the studies reviewed that have used education and reminders, audit and feedback, computer physician entry order systems, and forcing restraints …”

“…They saw a significant decrease in total number of laboratory tests ordered per patient‐day as well as decreased number of duplicate blood tests. Sadowski et al also used an order set restriction approach in their study. They created two interventions, the first was removing the ability to order laboratory tests indefinitely and allowing them only to be ordered once.…”

“…One such tool is the Hierarchy of Effectiveness, a widely Table 1 lists the studies reviewed that have used education and reminders, [15][16][17][18] audit and feedback, [19][20][21] computer physician entry order systems, [22][23][24] and forcing restraints. [25][26][27][28][29][30] So, while education is always a component of changing ordering behaviors, there is a limited role for education as a sole intervention given the lack of long-term effects. In total, these negative studies suggest that lack of awareness of guidelines contributes minimally to inappropriate laboratory test ordering.…”

Effectiveness of provider price display in computerized physician order entry (CPOE) on healthcare quality: a systematic review

“…While price display did not result in consistent reduction in laboratory test utilization, other equally simple design-based interventions, such as eliminating default daily laboratory draw frequencies in EHR, resulted in significant reduction. 24,41,42 Eliminating default daily laboratory orders is a particularly promising intervention as the prevalence of patients receiving admission day orders for daily recurring laboratory tests has been reported to be as high as 95% in a large urban teaching hospital. 42 An argument can be made about improving the design of existing passive price display tools to create interactive second-generation price display tools based on sophisticated clinical decision support architecture.…”

“…Price display on paper in the non-electronic health record era was associated with reduced costs. 8,9 Coinciding with the introduction of electronic health records (years 1990-2000) and the diffusion of EHR adoption (years 2000-2015), various authors [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] studied the impact of price display during computerized physician order entry on domains of healthcare quality such as efficiency, effectiveness, and safety. These studies differed in the setting, and design, as well as their conclusions.…”