Reducing Unnecessary Noninvasive Testing for Inpatients With Unstable Angina: The RUNIT Protocol

Diagnostic stewardship: Improving use of diagnostic tests for better quality and value in hospital medicine

“…12 Interventions could then be targeted to optimize use in areas of high need. Example interventions include: (a) implementing an order set that recommends inpatient versus deferred outpatient versus no echocardiography testing based on indication, 13 (b) making it harder to order an inpatient echocardiography (e.g., requiring a phone call in addition to the computer order), (c) automatic cancellation of duplicate testing, 14 or (d) auditing orders and providing feedback to clinicians when echocardiograms have low-value indications. 13 Thinking more broadly, the range of potential diagnostic stewardship solutions could include: blood culture ordering (e.g., not obtaining them in pneumonia without sepsis, obtaining before antibiotics in patients at high risk of bacteremia), reducing repeat or routine (e.g., daily complete blood count) laboratory testing, 15 promoting appropriate diagnostic testing for pulmonary embolism (e.g., Pulmonary Embolism Rule-Out Criteria), 16 and innumerable others that are often the focus of hospital medicine quality improvement interventions.…”

“…Interventions could then be targeted to optimize use in areas of high need. Example interventions include: (a) implementing an order set that recommends inpatient versus deferred outpatient versus no echocardiography testing based on indication, 13 (b) making it harder to order an inpatient echocardiography (e.g., requiring a phone call in addition to the computer order), (c) automatic cancellation of duplicate testing, 14 or (d) auditing orders and providing feedback to clinicians when echocardiograms have low‐value indications 13 . Thinking more broadly, the range of potential diagnostic stewardship solutions could include: Test selection : create an order set that guides clinicians to the right cardiac test (e.g., transesophageal vs. transthoracic vs. stress echocardiography vs. no testing) based on the indication.…”