Signage as an intervention on a general medicine ward to reduce unnecessary testing

Wiens, Evan J.; Supel, Izabella; Gallardo, J. Cebrian; Seifer, Colette

doi:10.1111/imj.14784

Cited by 2 publications

(1 citation statement)

References 4 publications

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“…One study posted signs on physician computers outlining test-ordering recommendations. 45 Gupta et al developed lectures for residents and allotted time for resident teams to peer-review orders. 33 Meanwhile, Almeqdadi et al incorporated audit and feedback with biweekly discussions of repercussions of unnecessary daily labs and provided positive reinforcement incentives (such as food) for those who followed the suggested guidelines.…”

Section: Resultsmentioning

confidence: 99%

Interventions to reduce repetitive ordering of low-value inpatient laboratory tests: a systematic review

Yeshoua

Bowman²,

Dullea

et al. 2023

BMJ Open Qual

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BackgroundOver-ordering of daily laboratory tests adversely affects patient care through hospital-acquired anaemia, patient discomfort, burden on front-line staff and unnecessary downstream testing. This remains a prevalent issue despite the 2013 Choosing Wisely recommendation to minimise unnecessary daily labs. We conducted a systematic review of the literature to identify interventions targeting unnecessary laboratory testing.MethodsWe systematically searched MEDLINE, EMBASE, Cochrane Central and SCOPUS databases to identify interventions focused on reducing daily complete blood count, complete metabolic panel and basic metabolic panel labs. We defined interventions as ‘effective’ if a statistically significant reduction was attained and ‘highly effective’ if a reduction of ≥25% was attained.ResultsThe search yielded 5646 studies with 41 articles that met inclusion criteria. We grouped interventions into one or more categories: audit and feedback, cost display, education, electronic medical record (EMR) change, and policy change. Most interventions lasted less than a year and used a multipronged approach. All five strategies were effective in most studies with EMR change being the most commonly used independent strategy. EMR change and policy change were the strategies most frequently reported as effective. EMR change was the strategy most frequently reported as highly effective.ConclusionOur analysis identified five categories of interventions targeting daily laboratory testing. All categories were effective in most studies, with EMR change being most frequently highly effective.PROSPERO registration numberCRD42021254076.

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Section: Resultsmentioning

confidence: 99%

Interventions to reduce repetitive ordering of low-value inpatient laboratory tests: a systematic review

Yeshoua

Bowman²,

Dullea

et al. 2023

BMJ Open Qual

View full text Add to dashboard Cite

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Simple signage and targeted education can lead to process improvement in acute appendicitis care

Atwood,

Benoit,

Hennrikus

et al. 2023

BMJ Open Qual

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IntroductionAn institution-wide protocol for uncomplicated acute appendicitis was created to improve compliance with best practices between the emergency department (ED), radiology and surgery. Awareness of the protocol was spread with the publication of a smartphone application and communication to clinical leadership. On interim review of quality metrics, poor protocol adherence in diagnostic imaging and antimicrobial stewardship was observed. The authors hypothesised that two further simple interventions would result in more efficient radiographic diagnosis and antimicrobial administration.Materials and methodsSurgery residents received targeted in-person education on the appropriate antibiotic choices and diagnostic imaging in the protocol. Signs were placed in the emergency and radiology work areas, immediately adjacent to provider workstations highlighting the preferred imaging for patients with suspected appendicitis and the preferred antibiotic choices for those with proven appendicitis. Protocol adherence was compared before and after each intervention.ResultsTargeted education was associated with improved antibiotic stewardship within the surgical department from 30% to 91% protocol adherence before/after intervention (p<0.005). Visible signs in the ED were associated with expedited antimicrobial administration from 50% to 90% of patients receiving antibiotics in the ED prior to being brought to the operating room before/after intervention (p<0.005). Diagnostic imaging after the placement of signs showed improved protocol adherence from 35% to 75% (p<0.005).ConclusionThis study demonstrates that smartphone-based applications and communication among clinical leadership achieved suboptimal adherence to an institutional protocol. Targeted in-person education reinforcement and visible signage immediately adjacent to provider workstations were associated with significantly increased adherence. This type of initiative can be used in other aspects of acute care general surgery to further improve quality of care and hospital efficiency.

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Signage as an intervention on a general medicine ward to reduce unnecessary testing

Cited by 2 publications

References 4 publications

Interventions to reduce repetitive ordering of low-value inpatient laboratory tests: a systematic review

Interventions to reduce repetitive ordering of low-value inpatient laboratory tests: a systematic review

Simple signage and targeted education can lead to process improvement in acute appendicitis care

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