Impact of Clinical Specialty on Attitudes Regarding Overuse of Inpatient Laboratory Testing

Korenstein, Deborah; Husain, Solomon; Gennarelli, Renee L.; White, Cilian; Masciale, James N.; Roman, Benjamin R.

doi:10.12788/jhm.2978

Cited by 12 publications

(8 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Routine, repetitive ordering of blood tests in hospital inpatients without clinical indications is a practice primarily enabled by healthcare providers. These tests are often ordered with the intent of excluding a diagnosis, helping with prognostication, or enhancing patient safety 4041. Similar to other types of low value care, this practice is driven by clinician habits, institutional culture, fear of litigation, and perceived pressure from families and caregivers 40.…”

Section: Barriers To Changementioning

confidence: 99%

“…These tests are often ordered with the intent of excluding a diagnosis, helping with prognostication, or enhancing patient safety 4041. Similar to other types of low value care, this practice is driven by clinician habits, institutional culture, fear of litigation, and perceived pressure from families and caregivers 40. However, hospital inpatients often inherently trust that blood tests are ordered purposefully, and are unlikely to pressure their clinicians into ordering routine, repetitive bloodwork 42.…”

Section: Barriers To Changementioning

confidence: 99%

See 1 more Smart Citation

Reducing routine inpatient blood testing

Silverstein

Weinerman

Born

et al. 2022

BMJ

View full text Add to dashboard Cite

Section: Barriers To Changementioning

confidence: 99%

Section: Barriers To Changementioning

confidence: 99%

Reducing routine inpatient blood testing

Silverstein

Weinerman

Born

et al. 2022

BMJ

View full text Add to dashboard Cite

“…However, unnecessary laboratory testing is prevalent and contributes to health care waste, often triggering a cascade of interventions without improving quality. [10][11][12][13][14][15] Given the common co-occurrence of IV placement, laboratory testing, and IVF initiation, interventions to change maintenance IVF prescribing practice present an opportunity to simultaneously reduce laboratory testing.…”

mentioning

confidence: 99%

Effect of a Quality Improvement Bundle to Standardize the Use of Intravenous Fluids for Hospitalized Pediatric Patients

et al. 2022

View full text Add to dashboard Cite

IMPORTANCEGiven that hypotonic maintenance intravenous fluids (IVF) may cause hospital-acquired harm, in November 2018, the American Academy of Pediatrics released a clinical practice guideline recommending the use of isotonic IVF for patients aged 28 days to 18 years without contraindications. No recommendations were made regarding laboratory monitoring; however, unnecessary laboratory tests may contribute to health care waste and harm patients.OBJECTIVE To examine the effect of a quality improvement intervention bundle on (1) increasing the mean proportion of hours per hospital day with exclusive isotonic IVF use to at least 80% and (2) decreasing the mean proportion of hospital days with laboratory tests obtained. DESIGN, SETTING, AND PARTICIPANTSThis stepped-wedge, cluster randomized clinical trial (Standardization of Fluids in Inpatient Settings [SOFI]) was sponsored by a national quality improvement collaborative and was conducted across 106 US pediatric hospitals. The SOFI intervention period was from September 2019 to March 2020.INTERVENTIONS Hospital sites were exposed to educational materials, a clinical algorithm and order set for IVF use, electronic medical record interventions to reduce laboratory testing, and "harms of overtesting" cards.MAIN OUTCOMES AND MEASURES Primary outcomes were mean proportion of hours per hospital day receiving exclusive isotonic IVF and mean proportion of hospital days with laboratory test values obtained. Secondary measures included total IVF duration per hospital day, daily patient weight measurement while receiving IVF, serum sodium testing, and adverse events. Baseline data were collected for 2 months; intervention period data, 7 months. Outcomes were analyzed using linear mixed-effects regression models.RESULTS A total of 106 hospitals were randomly assigned to 1 of 3 intervention start dates (wedges), and 100 hospitals (94%) completed the study. In total, 5215 hospitalizations were reviewed before the intervention, and 6724 hospitalizations were reviewed after the intervention. Prior to interventions, the mean (SD) proportion of hours per day with exclusive isotonic IVF use was 88.5% (31.7%). Interventions led to an absolute increase of 5.4% (95% CI, 3.9%-6.9%) above baseline in exclusive isotonic IVF use but did not change the proportion of hospital days during which a laboratory test value was obtained (estimated difference, 0.1%; 95% CI, -1.5% to 1.7%; P = .90), IVF use duration (estimated difference, -1.2%; 95% CI, -2.9% to 0.4%), serum sodium testing, or adverse events. There was an absolute increase of 4.4% (95% CI, 2.6%-6.2%) in the mean proportion of hospital days with a patient weight measurement while receiving IVF. CONCLUSIONS AND RELEVANCEIn this stepped-wedge, cluster randomized clinical trial, an intervention bundle significantly improved the use of isotonic maintenance IVF without a concomitant increase in adverse events or electrolyte testing. Further work is required to deimplement laboratory testing.

show abstract

“…

Frequent daily laboratory testing for inpatients contributes to excessive costs, 1 anemia, 2 and unnecessary testing. 3 The ABIM Foundation's Choosing Wisely ® campaign recommends avoiding routine labs, like complete blood counts (CBCs) and basic metabolic panels (BMP), in the face of clinical and laboratory stability. 4,5 Prior interventions have reduced unnecessary labs without adverse outcomes.

…”

mentioning

confidence: 99%

Evaluation of the Order SMARTT: An Initiative to Reduce Phlebotomy and Improve Sleep-Friendly Labs on General Medicine Services

et al. 2020

View full text Add to dashboard Cite

We assessed the effectiveness of a quality improvement project to reduce routine labs in clinically stable patients, while also promoting sleep-friendly lab timing. The electronic health record was modified with an “Order Sleep” shortcut to facilitate sleep-friendly lab draws. A “4 am Labs” column was added to electronic patient lists to signal which patients had early morning labs ordered. Among 7,045 patients over 50,951 total patient-days, on average we observed 26.3% fewer routine lab draws per patient-day per week postintervention (4.68 before vs 3.45 after; difference, 1.23; 95% CI, 0.82-1.63; P < .05). In interrupted time series analysis, the “Order Sleep” tool was associated with a significant increase in sleep-friendly lab orders per encounter per week on resident medicine services (intercept, 1.03; standard error (SE), 0.29; P < .001). The “4 am Labs” column was associated with a significant increase in sleep-friendly lab orders per patient encounter per week on the hospitalist medical service (intercept, 1.17; SE, 0.50; P = .02). We demonstrate the success of an initiative to simultaneously reduce daily labs and improve sleep-friendly ordering. Journal of Hospital Medicine 2020;15:XXX-XXX. © 2020 Society of Hospital Medicine

show abstract

Impact of Clinical Specialty on Attitudes Regarding Overuse of Inpatient Laboratory Testing

Cited by 12 publications

References 15 publications

Reducing routine inpatient blood testing

Reducing routine inpatient blood testing

Effect of a Quality Improvement Bundle to Standardize the Use of Intravenous Fluids for Hospitalized Pediatric Patients

Evaluation of the Order SMARTT: An Initiative to Reduce Phlebotomy and Improve Sleep-Friendly Labs on General Medicine Services

Contact Info

Product

Resources

About