Decreasing Unnecessary Daily Labs by Choosing Wisely

Abstract

Introduction: The utilization of laboratory services has increased across various healthcare settings. We assessed the impact of the implementation of a Quality Improvement project aimed at reducing Complete Blood Count (CBC) and Basic Electrolyte Panel (BEP) ordered by house staff physicians. Materials and Methods: This study with a pre-post design was conducted in a community hospital in Connecticut, USA. The study was performed between January 2014 and December 2016. At initiation of the project, a taskforce consisting of attending doctors and house staff physicians was created. The taskforce reviewed and determined the current practices of ordering CBC and BEP. The taskforce members analyzed every step of the process and unveiled circumstances where unnecessary CBC and BEPs were ordered. Based on the results of the analysis, a multi-level intervention of one-year duration was then developed to address the ordering of unnecessary CBC and BEPs. The intervention consisted of daily decision making about labs during rounds, incorporating lab documentations planned for the next day into daily progress notes, including the rationale for these labs, audit and reporting of ordering practices to each medical team, and providing direct feedback to each house staff not providing appropriate documentation of lab rationale. The average numbers of CBC and BEP orders per patient days were used to assess the impact of our intervention. Results:After implementing this Quality Improvement program, the average number of CBC and BEPs per patient days ordered by the house staff physicians decreased (i.e., from 1.20 to 1.09; P<0.01, and from 0.88 to 0.80; P<0.01, respectively). This corresponds to a reduction of 9% in both CBC and BEP orderings per patient days. There were no unintended adverse consequences from the interventions. Conclusion: Our Quality Improvement initiative resulted in a reduction in CBC and BEP orderings per patient days by the house staff without adversely affecting our patients’ length of stay or mortality.