Lab Utilization Research Articles

Utility of preoperative labs in posterior spinal fusions for idiopathic scoliosis.

Review of 216 consecutive idiopathic scoliosis (IS) patients undergoing posterior spinal fusion (PSF) demonstrated 94.9% having abnormal lab values, but only 3.9% were referred for further evaluation. A limited set of preoperative laboratory testing costing $234/patient, and thorough, adjunct review of patient/family history could identify potentially significant comorbidities preoperatively in this study. A savings of $1556/patient from current laboratory testing was identified. The laboratory tests routinely obtained preoperatively were investigated: abnormal preoperative laboratory outcomes were identified and further documented if additional action was taken defined as a referral to another medical provider, performance of additional lab testing or counseling, or if there was alteration of the surgical plan. Overall, 94.9% (n = 205) of patients had one or more abnormal pre-operative lab values. Further actions occurred in 11.7% (n = 24) of all abnormal lab values with 3.9% (n = 8) of these being referred to other healthcare providers. Sixteen abnormal lab values underwent further testing or treatment: 11 nicotine tests, two UCx, one UA, one PT/PTT, and one bovine gelatin RAST. Eight abnormal tests prompted referral to another provider: three CBC, three platelet function tests, one UCx, and one UA. Based on these data, standard preoperative Hgb/Hct, platelet function tests, and bovine RAST (If the surgical plan involves use of bovine gelatin products) appear to be adequate to identify potential significant comorbidities in IS patients undergoing PSF for only $234/patient, a cost savings of $1556/patient from current protocol. Based on this study of 216 patients, a limited preoperative laboratory testing and thorough, adjunct review of patient/family history appears to be adequate to identify potential comorbidities preoperatively in this study. II.

에너지 섹터의 혁신성 제고를 위한 리빙랩 활용 전략 수립에 관한 연구

에너지 섹터의 혁신성 제고를 위한 리빙랩 활용 전략 수립에 관한 연구

Utility of Nonspecific Laboratory Testing for Psychiatric Patients Undergoing Medical Screening in a Military Emergency Department.

Psychiatric complaints account for a sizable and increasing portion of emergency department (ED) visits. Compared with other medical patients, these patients often require substantial resources because of limited specialized resources and prolonged boarding times, which can be detrimental to the safety and satisfaction of other patients. This can prompt early and indiscriminate laboratory testing to expedite early requests for admission consideration. Numerous emergency medicine literature and clinical policies already recommend against indiscriminate screening labs for these patients, yet many psychiatric services require these tests. This study further evidences the limited clinical utility and high associated costs of mandatory protocol screening labs for psychiatric patients evaluated in military EDs. A retrospective chart review of 441 active duty military patients and their families presenting to Madigan Army Medical Center's ED who received psychiatric diagnoses underwent analysis. A 3-physician review panel evaluated each identified patient case to confirm eligibility and determine whether or not laboratory studies led to a change in patient disposition that was not identified by history, review of systems, physical exam, and known past medical history. The review was approved by the hospital's institutional review board. Contemporary laboratory tests ordered in the evaluation of these patients included complete blood count with differential, complete metabolic panel, thyroid-stimulating hormone, serum ethanol, serum acetaminophen, serum salicylates, urine drug screening, urinalysis, urine human chorionic gonadotropin, and electrocardiograms. Broad screening labs may have altered dispositions for 0.9% (4) of patients. In total, 93% (202) of admitted patients were dispositioned to a psychiatric service. Of the 15 patients admitted to a medical service, 10 involved overdoses or intoxication. One patient had anemia in addition to opioid use disorder as diagnoses and was dispositioned to a medicine service. One pediatric patient was admitted for observation only. The remaining patients had diagnoses based on physical exam and history requiring medical service admission. In total, 7 patients had unknown dispositions, of which 4 carried solely psychiatric diagnoses. The cumulative reimbursement costs of broad testing in the studied population were estimated at $36,325.17 and rarely altered patient disposition. Further testing does not increase the incidence of disposition altering diagnoses and is associated with increased costs. When individual state laws and the clinical assessment by the responsible emergency physician are considered, future standardized ED lab screening evaluations of psychiatric patients in military EDs may be concentrated to breathalyzer alcohol level, urine drug screen, serum salicylates, serum acetaminophen, and urine human chorionic gonadotropin.

A Pathway for Community-Acquired Pneumonia With Rapid Conversion to Oral Therapy Improves Health Care Value.

BackgroundEvidence supports streamlined approaches for inpatients with community-acquired pneumonia (CAP) including early transition to oral antibiotics and shorter therapy. Uptake of these approaches is variable, and the best approaches to local implementation of infection-specific guidelines are unknown. Our objective was to evaluate the impact of a clinical decision support (CDS) tool linked with a clinical pathway on CAP care.MethodsThis is a retrospective, observational pre–post intervention study of inpatients with pneumonia admitted to a single academic medical center. Interventions were introduced in 3 sequential 6-month phases; Phase 1: education alone; Phase 2: education and a CDS-driven CAP pathway coupled with active antimicrobial stewardship and provider feedback; and Phase 3: education and a CDS-driven CAP pathway without active stewardship. The 12 months preceding the intervention were used as a baseline. Primary outcomes were length of intravenous antibiotic therapy and total length of antibiotic therapy. Clinical, process, and cost outcomes were also measured.ResultsThe study included 1021 visits. Phase 2 was associated with significantly lower length of intravenous and total antibiotic therapy, higher procalcitonin lab utilization, and a 20% cost reduction compared with baseline. Phase 3 was associated with significantly lower length of intravenous antibiotic therapy and higher procalcitonin lab utilization compared with baseline.ConclusionsA CDS-driven CAP pathway supplemented by active antimicrobial stewardship review led to the most robust improvements in antibiotic use and decreased costs with similar clinical outcomes.

Experience and Challenges of Objective Structured Clinical Examination (OSCE): Perspective of Students and Examiners in a Clinical Department of Ethiopian University.

Invented nearly half a century ago, Objective Structured Clinical Examination (OSCE) is overwhelmingly accepted clinical skills assessment tool and has been used worldwide for evaluating and teaching learners' competences in health care disciplines. Regardless of factors affecting the attributes, OSCE is considered as reliable and powerful tool with certain validity evidences. In spite of its advantages and various promotion efforts, the progress of OSCE implementation in Ethiopian public universities has not been satisfactory. Therefore, the objective of this study was to explore the experience and challenges of OSCE implementation from the perspective of clinical year-II medical students and their examiners in Ob-Gyn Department of Jimma University. Forty-nine students and seven examiners voluntarily participated in Ob-Gyn Department where OSCE has been used as one of summative assessment methods. Qualitative study design using structured open-ended questionnaire as a tool and descriptive phenomenology as underpinning method were employed. Collaizzi's descriptive analysis was used as phenomenological analysis approach. Poor organization, inadequate student preparation time, and inadequate number and duration of stations were thematically emerged as umbrellas of factors negatively affecting OSCE implementation. Satisfaction with OSCE was the only theme with findings that encourage OSCE implementation. There should be team approach, shared responsibility and proper planning among faculty to minimize hindering factors of OSCE implementation. Besides faculty development on OSCE, the department should improve skill lab utilization arranging schedule for both students and faculty members to increase guided students' exposure to simulation-based learning and ultimately enhance OSCE implementation.

Virtual laboratory for enhancing students’ understanding on abstract biology concepts and laboratory skills: a systematic review

The virtual laboratory has been widely used in biology learning at all levels of education, but it remains a challenge for countries with technological shortages. Many biological concepts were abstract and difficult to be understood through simple explanation or even difficult to do in a laboratory. Utilization of virtual labs in biology learning, especially in higher education needs to be reviewed about the characteristics of contents, and function and its efficiency to assess the specific variables. Thus, this systematic review was carried out to analyze research articles published from 2010 to 2018. The articles were selected using the PRISMA. The articles were obtained from Google Scholar, the Science Direct, and the Journal of Science Education, ERIC, and Journal of Biological Education. In total, 199 articles were found. The general analysis was conducted. The results yielded 47 articles to be further analyzed by looking at the content and results of the study. Twenty-three articles were obtained and analyzed. Journal content analysis was focused on the selected topic, the dependent variables, sample size, effect size, research design, data collection techniques, research objectives, and the results. Cell or molecular biology was the most widely used topics in the virtual laboratory. Students’ conceptual understanding was the most studied variable, some studies examine students’ affective and psychomotor skills, but only a few studies examine the learning process. Most biology virtual labs were developed using the Adobe Flash Player application with 3D animation. The results suggested for further research to develop a virtual biology lab that is more inquiry-based, and capable of assessing students’ conceptual change and science process skills which not have been widely studied.

PhET Aplication Program: Strategi Menguatkan Pemahaman Siswa pada Materi Listrik DC melalui Pembelajaran Berbantu Lab Virtual

This article aims to improve the understanding of DC electrical material by utilizing the PhET circuit-construction-kit-DC application. Learning activities using the Smartloop method and the utilization of virtual labs to facilitate students to solve the problem of electrical circuit material on the law II Kirchoff, more specifically in the closed circuit two loops that the way of completion is very complex with mathematical counts. From the experience of teaching students in the class XII IPA beginning in the school year 2018/2019 received positive note: 1) DC Electrical Learning assisted by PhET applications can be done through online or offline utilization of the Phet circuit-construction-kit-DC application supported by the Smartloop method, makes solving DC electrical problems easier and simpler; 2) The presentation of learning becomes more meaningful, the use of the Phet circuit-construction-Kit-DC application with the Smartloop method continues to prioritize the mastery of basic concepts, follow the rules/Use the principles or agreements that have been prevalent, and use reasoning. The results showed: a) students are more enthusiastic about learning, with indications of students eager to teach their peers who still do not understand the learning process in class and have fun lingering in front of the monitor screen; b) Students are more confident with the learning outcomes, because they can match the results using the usual process and how smartloop and the use of PhET circuit-construction-kit-DC; c) Better learning outcomes.

Utility of Computer Labs in Secondary Schools as Perceived by Students With Diverse Demographics

The accessibility of modern computer technologies in schools is increasing all over the globe. Generally, the presence of a well-equipped and functional computer lab facility in school provides the opportunity not only to modernize educational methods but also to augment students and teachers’ interest towards the efficient use of computer technology along with access to quality education. In line with prevailing global trends, federal and provincial governments in Pakistan especially Government of the Punjab also made concerted efforts to provide computer lab facility in secondary schools in past two decades. In this context, this article mainly focused on examining the usefulness of computer labs for enhancement of secondary school students learning experiences. Descriptive survey design was used to achieve the objectives of this study in which a self-developed questionnaire designed on Likert five-point format was administered to 320 sample students selected from 32 secondary schools using cluster and stratified random sampling techniques. Both the descriptive (i.e., percentage, mean, SD) and/or inferential statistics (i.e., independent-sample t-test) were used to analyze collected data. The results revealed that secondary school students believe, with a higher level of consensus, that computer labs are useful for enhancement of their learning. Some concerns, however, were also highlighted by students regarding the availability of required physical facilities in computer labs. It was recommended for school authorities to provide well-equipped and fully functional computer labs in schools to achieve maximum benefits for students.

Impact of coronavirus disease 2019 lockdown on catheterization laboratory: An Indian perspective

Aims: This study aims to study the impact of coronavirus disease 2019 (COVID-19) lockdown on catheterization laboratory (Cath Lab) utilization for cardiac patients. Subjects and Methods: In this retrospective observational study, a total number of procedures in Cath Lab during COVID-19 lockdown were compared with pre-COVID-19 lockdown time to see the impact of the pandemic on cardiac patients undergoing interventions. Results: A total of 1982 procedures (1788 in prelockdown vs. 194 in lockdown; P Conclusions: We report an alarming reduction in total admissions and catheterization laboratory procedures as an impact of COVID-19-related lockdown. This represents a serious problem regarding the handling of this pandemic by the health-care system and can be used to devise proper strategies for the recovery phase of the COVID-19 pandemic.

Virtual Laboratory for Elementary Students

Experiment-based science learning for elementary school children in Indonesia is constrained by infrastructure. Only a few elementary schools have integrated laboratories, which led to science-based thematic learning mostly limited to conceptual or theoretical. The solution offered by this article is the use of a virtual laboratory (VLab-“little scientist”) designed specifically for elementary school students. The little scientist simulates several types of basic experiments using attractive, colorful, and simple visual displays that are easily understood by the young learner. The Virtual Lab-little scientist was developed using the RnD method and operated using screen-based hardware like PC or Mobilephone. The VLab-little scientist was tested on 4th and 5th graders of Elementary School. The test results that the utilization of virtual labs is able to improve students’ science process skills. Students were able to experiment with real equipment, after using the VLab-little scientist. Subsequent development needs to consider the elementary school science curriculum and further test to explore the effectiveness of using virtual lab.

Laboratory S et up P rocess and K ey F actors I nvolved to Set Bench M arking for University

Laboratory set-up plays a significant role in the college in light of the fact that the greater part of the mishaps occurred because of carelessness of faculty defensive gear (PPE), poor wellbeing standards and absence of legitimate direction to understudies about utilization of machines and synthetic concoctions so there are many factors which are to be considered like health and safety for users, maintain OSHA standards[1-5], set bench marking among university, cost cutting, maximum utilization of lab’s area, power saving etc. In this paper we have done complete study on lab infrastructure and also implemented in our university. As Dubai is very strict on health and safety so one more important thing is that we have followed all compliances of Dubai monitoring authorities like Dubai municipality, education department, police department and health department.

Amylase and Lipase Co-ordering in the Workup of Pancreatic Disorders Is Unnecessary and Costly: An Institutional Lab Utilization Study

Abstract Background Acute pancreatitis is the most common gastrointestinal cause of hospitalization in the United States. Amylase and lipase are commonly ordered together in the workup of suspected pancreatitis at our institution (a large academic medical center), despite meta-analyses and evidence-based guidelines that recommend the use of lipase alone. Lipase has more diagnostic accuracy, rises earlier, and stays elevated longer than amylase. Co-ordering amylase has not been shown to increase sensitivity or specificity. This study aims to explore how well amylase and lipase correlate in our patient population, and which marker more accurately detects acute pancreatitis when the results are discrepant. Methods The laboratory information system was queried for co-orders of amylase and lipase during a 2-month period (November 1, 2016, to December 31, 2016). The overall agreement and Cohen’s kappa were calculated. Discrepant results were separated from concordant results. Clinical data were extracted from the electronic medical record, including the rationale for ordering and relevant diagnosis code. Results There were 962 instances of amylase and lipase co-orders in the 2-month period. Of these, 138 had high amylase and lipase, and 694 had normal amylase and lipase concentrations. The overall agreement was 86.5% and Cohen’s kappa was 0.596 (moderate agreement) (P < .0001). There were 88 cases in which the lipase was elevated and the amylase was normal. Of these, 12 were acute pancreatitis and 76 were not. There were 42 cases in which the amylase was elevated and the lipase was normal; only one case out of 42 was acute pancreatitis. Further investigation into this case revealed that the patient was approximately 7 months status-post pancreas transplant. During this admission, he was diagnosed with “graft pancreatitis” and, while amylase remained elevated above the reference range for longer than lipase after treatment, both enzymes were increased at diagnosis (lipase 831 U/L [73-393 U/L] and amylase 194 U/L [30-110 U/L]). These data show that, had only lipase been ordered, no cases of acute pancreatitis would have been missed. Conclusion Amylase has been shown to be an inferior marker of acute pancreatitis compared to lipase, and many guidelines recommend the use of lipase alone. However, these tests are commonly co-ordered at our institution; in a given 2-month period, there were 962 co-order events. Of these, there were no cases of pancreatitis that would have been missed by ordering lipase alone. Our laboratory charges $50 per amylase assay; therefore $48,100 was spent on unnecessary amylase orders during the 2 months of this study. Lab test overutilization has been identified as an important problem; if addressed and curtailed, labs and hospitals can increase efficiency and cost savings.

Utility of Preoperative Labs in Posterior Spinal Fusions for Adolescent Idiopathic Scoliosis

Utility of Preoperative Labs in Posterior Spinal Fusions for Adolescent Idiopathic Scoliosis

Preferred learning modalities and practice for critical skills: a global survey of paediatric emergency medicine clinicians

ObjectiveTo describe senior paediatric emergency clinician perspectives on the optimal frequency of and preferred modalities for practising critical paediatric procedures.MethodsMulticentre multicountry cross-sectional survey of senior paediatric emergency clinicians working in...

Operational Efficiency and Productivity Improvement Initiatives in a Large Cardiac Catheterization Laboratory

ObjectivesThis study sought to report outcomes from an efficiency improvement project in a large cardiac cath lab. BackgroundOperational inefficiencies are common in the cath lab, yet solutions are challenging. A detailed report describing and providing solutions for these inefficiencies may be valuable in guiding improvements in productivity. MethodsIn this observational study, the authors report metrics of efficiency before and after a cath lab quality improvement program in June 2014. Main outcomes included lab room start times, room turnaround times, laboratory use, and employee satisfaction. Time series analysis was used to assess trend over time. Chi-square testing and analysis of variance were used to assess change before and after the initiative. ResultsThe principal changes included implementation of a pyramidal nursing schedule, increased use of an electronic scheduling system, and increased utilization of a preparation and recovery area. Comparing before with after the program, start times improved an average of 17 min, and on-time starts improved from 61.8% to 81.7% (p = 0.0024). Turnaround times improved from 20.5 min to 16.4 min (trend p < 0.0001), and the proportion of days at full lab utilization improved from 7.7% to 77.3% (p < 0.00001). There were no increases in overtime, night, or weekend cases. There was a reduction in full time employees from 36.1 in 2013 to 29.6 in 2016, with an improvement in employee satisfaction. ConclusionsA systematic approach to reducing inefficiencies can improve cath lab start times, turnaround times, and overall productivity. This knowledge may be helpful in assisting other cath labs in similar efficiency improvement initiatives.

The Impact of an Emergency Department Front-End Redesign on Patient-Reported Satisfaction Survey Results.

IntroductionFor emergency department (ED) patients, delays in care are associated with decreased satisfaction. Our department focused on implementing a front-end vertical patient flow model aimed to decrease delays in care, especially care initiation. The physical space for this new model was termed the Flexible Care Area (FCA). The purpose of this study was to quantify the impact of this intervention on patient satisfaction.MethodsWe conducted a retrospective study of patients discharged from our academic ED over a one-year period (7/1/2013–6/30/2014). Of the 34,083 patients discharged during that period, 14,075 were sent a Press-Ganey survey and 2,358 (16.8%) returned the survey. We subsequently compared these survey responses with clinical information available through our electronic health record (EHR). Responses from the Press-Ganey surveys were dichotomized as being “Very Good” (VG, the highest rating) or “Other” (for all other ratings). Data abstracted from the EHR included demographic information (age, gender) and operational information (e.g. – emergency severity index, length of stay, whether care was delivered entirely in the FCA, utilization of labs or radiology testing, or administration of opioid pain medications). We used Fisher’s exact test to calculate statistical differences in proportions, while the Mantel-Haenszel method was used to report odds ratios.ResultsOf the returned surveys, 62% rated overall care for the visit as VG. However, fewer patients reported their care as VG if they were seen in FCA (53.4% versus 63.2%, p=0.027). Patients seen in FCA were less likely to have advanced imaging performed (12% versus 23.8%, p=0.001) or labs drawn (24.8% vs. 59.1%, p=0.001). Length of stay (FCA mean 159 ±103.5 minutes versus non-FCA 223 ±117 minutes) and acuity were lower for FCA patients than non-FCA patients (p=0.001). There was no statistically significant difference between patient-reported ratings of physicians or nurses when comparing patients seen in FCA vs. those not seen in FCA.ConclusionPatients seen through the FCA reported a lower overall rating of care compared to patients not seen in the FCA. This occurred despite a shorter overall length of stay for these patients, suggesting that other factors have a meaningful impact on patient satisfaction.

Pediatric invasive fungal rhinosinusitis: An investigation of 17 patients

PurposeTo investigate outcomes of pediatric patients at a single institution with invasive fungal rhinosinusitis (IFRS) and to determine variables that impact overall survival. MethodsAll pediatric patients at a large tertiary children's hospital diagnosed with IFRS confirmed by surgical pathology from 2009 to 2015 were retrospectively reviewed. Demographics, underlying diseases, symptoms, antifungal therapy, absolute neutrophil count (ANC), surgical management,and outcomes were analyzed. ResultsSeventeen patients were identified with IFRS with an average age of 8.7 years and 53% male. Hematologic malignancy was the most common (n = 13) underlying disease. The most common presenting symptoms were fever (82%) and congestion (41%). 15 patients had severe neutropenia (Absolute Neutrophil Count (ANC) < 500) within 2 weeks prior to diagnosis. The average ANC at time of diagnosis was 1420 cells/uL. 16 patients were treated with serial nasal endoscopy and debridement, while 1 patient was treated with an open approach. 16 received combination antifungals while 1 was treated with amphotericin monotherapy. The most common genus cultured was Fusarium (n = 6). The average number of surgical interventions was 3.4, with the average interval between interventions 6.2 days. 13 of 17 (76%) were cleared of IFRS. Overall survival at 6 months was 41%. ConclusionPediatric IFRS is a life-threatening disease that requires a coordinated surgical and medical approach. Despite a relatively high local control rate, overall mortality remains disappointingly high, reflecting the disease's underlying pathogenesis - lack of host defense and risk of disseminated fungal infection. Further investigation is necessary to reveal optimal management with regards to antifungal therapy, surgery, and utility of labs.

Improving the process efficiency of catheterization laboratories using simulation

As the size of the population suffering from cardiac problems increases, the number of catheterization procedures performed is growing rapidly. The high costs associated with catheterization laboratories (cath labs) make managing these resources a critical task that impacts the efficiency and operating costs of hospitals as well as the quality of care. This study describes a discrete event simulation model developed to analyze the various factors that affect utilization of cath labs at a 337-bed full-service hospital in Scottsdale Arizona and provide decision support for improving the efficiency of the cath lab operations. The simulation model helped evaluate the performance of the existing approach at the hospital and compare alternative policies to improve operational efficiency. We consider both operational and patient satisfaction metrics and illustrate the tradeoffs between the two. Our analysis recommends reducing the initial time allotted to each case from 120 to 90 min, including a 30-min lunch buffer and end of the day buffer to absorb any delays, and potentially rescheduling inpatients when emergent cases have to be scheduled or other cases are taking longer than anticipated. We also perform detailed parametric analysis to develop more generic recommendations. The facility under study implemented our recommendations and realized a 19% increase in utilization as well as a 71% decrease in overtime.

Abstract 233: Practice Process Variability and Outcomes, Relation to Interventionalist Volume

Background: For the hospital, the cardiac catheterization lab is a high risk, high volume, high cost center. With the evolving imperative to provide value over volume, cardiac catheterization lab utilization, processes, and outcomes are an increasing focus of both internal and external scrutiny on an individual operator and aggregate basis. A hospital initiated multidisciplinary task force reviews real time and quarterly data from the NCDR and New York State to provide operator and cath lab managerial feedback, modify practice, and to assess progress. Ongoing interventions include; worksheets, EMR and Cath Lab templates, timely data review and feedback to managerial staff and operators. Methods: Stony Brook University has an open Cardiac Cath Lab with services provided by 5 full time faculty and 12 voluntary (private practice) interventional cardiologists. Using internal, NYS [2009-2015], and 2015 NCDR data, utilization, processes, and outcomes of high volume [HV] operators [&gt;100 PCI/yr] and those with a disproportionate rate of cath to PCI conversions [&gt;50%] were compared to lower volume [LV] and low conversion rate operators. Results: High volume operators [6] performed an average of 171 interventions compared to an average of 36 for LV operators [11]. Cases rated appropriate increased from 26% (102 of 391) in 2010 to 96.4% (1448 of 1502) in 2015. Cases rated inappropriate decreased from 24.8% (97 of 391) in 2010 to 1.0% (15 of 1502) in 2015; HV operators 0.5% versus 2.2% LV operators in 2015. The cases rated uncertain also decreased from 49% (192 of 391) in 2010 to 2.6% (39 of 1502) in 2015; HV operators 1.6% versus 5.1% for LV operators in 2015. This is statistically significant with p &lt; 0.05 by chi-square. Process indicators of stent utilization/case [1.8 vs 1.6] and contrast use [179 vs 166 cc/case] were similar in HV and LV operators with an increase in fluoroscopy times [20.2 vs 18.3 min], Total Area Dose [11,017 vs 9,154], Skin Dose 1,759 vs 1,536] in the LV operators. Bleeding complications were higher [5.8% vs 2.1%] in HV operators and mortalities were confined to the HV operators and those performing STEMI interventions. Conclusions: A multidisciplinary task force is an effective method of targeting multiple variables impacting on cath lab value metrics. Marked progress has been made towards the consistent and appropriate use of cardiac catheterization and angioplasty. The highest rates of cath-PCI conversion, bleeding complications and mortality were for HV full time cardiologists, providing 7x24 coverage for STEMI interventions and caring for a disproportionate number of ACS patients. Initiated processes, oversight and feedback changes have effectively minimized process and potential outcome differences between high and low volume operators.

Optimizing Laboratory Test Utilization in Long-Term Acute Care Hospitals

Laboratory tests can be considered inappropriate if overused or when repeated, unnecessary “routine” testing occurs. For chronically critically ill patients treated in long-term acute care hospitals (LTACHs), inappropriate testing may result in unnecessary blood draws that could potentially harm patients or increase infections. A quality improvement initiative was designed to increase physician awareness of their patterns of lab utilization in the LTACH environment. Within a large network of LTACHs, 9 hospitals were identified as having higher patterns of lab utilization than other LTACHs. Meetings were held with administrative staff and physicians, who designed and implemented hospital-specific strategies to address lab utilization. Lab utilization was measured in units of lab tests ordered per inpatient day (lab UPPD) for 8 months prior to the initial meeting and 7 months after the meeting. A repeated measures mixed model determined that postintervention lab utilization improved, on average and adjusted by case mix index, by 0.37 lab UPPD (t = −3.61, 95% CI 0.17 to 0.58) compared to the preintervention period. Overall, the case mix index 8 months prior to the intervention was no different than it was 7 months after the initial meeting (t[8] = −0.96, P = 0.37). Patient safety and outcome measures, including percentage of patients weaned from a ventilator, readmission rates, central catheter utilization rates, and the incidence of methicillin-resistant Staphylococcus aureus and other multidrug resistant organisms, showed no significant change. Hospital staff meetings focused on lab utilization and the development and deployment of tailored lab utilization strategies were associated with LTACHs achieving significantly lower lab utilization without negatively impacting quality outcomes.