Reducing unnecessary testing: an intervention to improve resident ordering practices

Melendez-Rosado, Jose; Thompson, Kristine M.; Cowdell, Jed C.; Sanchez-Alvarez, Catalina; Ung, Ryan; Villanueva, Armando; Jeffers, Kayin; Imam, J. Saadi; Mitkov, Mario; Kaleem, Tasneem; Jacob, Lewis; Dawson, Nancy L.

doi:10.1136/postgradmedj-2016-134513

Cited by 23 publications

(17 citation statements)

References 18 publications

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“…Melendez-Rosado et al 16 demonstrated that a programme of education had no significant impact on the ordering behaviour of medical residents. However, Miyakas et al 12 were able to demonstrate a decrease in the number of inappropriate tests ordered by trainee doctors after an educational session, although the effect was short-lived and only lasted one semester 12.…”

Section: Discussionmentioning

confidence: 99%

Reducing the number of unnecessary routine laboratory tests through education of internal medicine residents

Faisal

Andres

Rind

et al. 2018

Postgraduate Medical Journal

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IntroductionThe Choosing Wisely guidelines advise against ordering routine blood tests for hospitalised patients unless they change management. Unnecessary testing can lead to adverse effects (eg, iatrogenic anaemia, poor sleep quality, risk for infections and increased cost of care).MethodsAn 8-week quality initiative aimed at reducing unnecessary blood tests was implemented in three internal medicine resident inpatient services. The initiative included a 30 min educational session, reminders prior to rotation and midrotation and posters in work areas that displayed lab pricing and urged judicious testing. Residents were encouraged to justify the purpose of ordering tests in their daily progress notes. Attending physicians were made aware of the initiative. Preintervention and postintervention time points were used to compare key metrics. A >10% decrease between time periods was used as an evaluation criterion.ResultsThere were 293 patient records reviewed in the preintervention period and 419 in the postintervention period. The two groups were similar in terms of age and gender. Median blood test count (complete blood count/basic metabolic profile/comprehensive metabolic profile) decreased from 4 to 2 tests per patient per day (50 % decrease) after the intervention. The median length of hospital stay decreased from 4.9 to 3.9 days (21% decrease). A decreased percentage of people requiring transfusions was also noted (2016: 6.1%, 2017: 2.9%).ConclusionThe frequency of unnecessary routine blood tests ordered in the hospital can be decreased by educating resident physicians, making them cost conscious and aware of the indications for ordering routine labs. Frequent reminders are needed to sustain the educational benefit.

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Section: Discussionmentioning

confidence: 99%

Reducing the number of unnecessary routine laboratory tests through education of internal medicine residents

Faisal

Andres

Rind

et al. 2018

Postgraduate Medical Journal

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“…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 …”

Section: Improving Test Utilizationmentioning

confidence: 99%

“…Melendez et al's study focussed around a 30‐minute teaching session for residents, followed by visual reminders of the cost of laboratory tests that were placed at computer stations. After 3 months of intervention, they found slight decrease in number of combined CBC and differentials ordered (the costlier combination) but noted an increase in total CBCs requested.…”

Section: Educational Interventionsmentioning

confidence: 99%

“…As general rule in quality improvement initiatives, the minimum intervention required to achieve the desired change should be used to help insure that unintended consequences are kept to a minimum [Colour figure can be viewed at wileyonlinelibrary.com] they order. 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.…”

Section: Improving Te S T Utiliz Ati Onmentioning

confidence: 99%

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

Jalbert

Gob

Chin‐Yee

2019

Int J Lab Hematology

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Recurrent, inappropriate laboratory testing is a costly and wasteful use of healthcare resources. Recognizing this problem, the American Board of Internal Medicine, Canadian Society of Internal Medicine, and the Canadian Association of Pathologist all supported the Choosing Wisely campaign to reduce laboratory investigations in patients who demonstrate clinical and laboratory stability. In this narrative, we review studies looking at a variety of approaches to reduce excessive testing including education, audit and feedback, computerized physician order entry system changes, and forcing functions. Each type of intervention has its own unique advantages and disadvantages, varying in complexity, disruptiveness, effectiveness, and sustainability. Before implementing any quality improvement project, it is important to analyze the local context to identify the root causes for the practice behavior and aim to use the minimal amount of intervention to achieve the desired result. Change is often incremental and will seldom occur with a single intervention or Plan‐Do‐Study‐Act cycle. Garnering the support of opinion leaders and a quality improvement team will help make the process and intervention a success.

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“…Implementing a variety of quality improvement projects and measures to increase the awareness about the AUC and facilitate its use can serve this purpose. Reminders to providers in the electronic medical record, smartphone applications and pocket cards can be employed to be effective tools in changing the culture of ordering unnecessary tests 46. Some institutions have a designated area near the providers’ desks or work stations where posters and flow charts are readily available to serve as a reminder for the quality improvement intervention.…”

Section: The Impact Of the Upcoming Reimbursement Changesmentioning

confidence: 99%

Appropriately testing patients with intermediate risk for coronary artery disease: how well are we doing?

Alsaad

Shapiro

2018

BMJ EBM

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Overtestingusing myocardial perfusion imaging is well documented in several studies in the literature. Few studies highlighted the importance of the appropriate use criteria for radionuclide myocardial perfusion imaging, which can reduce unnecessary testing in patients with suspected coronary artery disease. Herein, we propose 'Simple Steps to Follow' to be considered by clinicians prior to ordering radionuclide myocardial perfusion imaging. The target audience of this article is internal and family medicine primary care physicians and other non-cardiologist physicians.

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Reducing unnecessary testing: an intervention to improve resident ordering practices

Cited by 23 publications

References 18 publications

Reducing the number of unnecessary routine laboratory tests through education of internal medicine residents

Reducing the number of unnecessary routine laboratory tests through education of internal medicine residents

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

Appropriately testing patients with intermediate risk for coronary artery disease: how well are we doing?

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