TY - JOUR
T1 - Reducing the number of unnecessary routine laboratory tests through education of internal medicine residents
AU - Faisal, Annum
AU - Andres, Kayla
AU - Rind, Jubran Afzal Khan
AU - Das, Aparna
AU - Alter, David
AU - Subramanian, Jeevarathna
AU - Koehler, Tracy J.
AU - Parker, Jessica
AU - Bernicchi, Nathan
N1 - Publisher Copyright:
© 2019 Author(s).
PY - 2018/12/1
Y1 - 2018/12/1
N2 - Introduction: The 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). Methods: An 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. Results: There 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%). Conclusion: The 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.
AB - Introduction: The 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). Methods: An 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. Results: There 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%). Conclusion: The 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.
KW - Anaemia
KW - graduate medical education
KW - medical overuse
KW - routine diagnostic tests
KW - stay length
UR - http://www.scopus.com/inward/record.url?scp=85060368481&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85060368481&partnerID=8YFLogxK
U2 - 10.1136/postgradmedj-2018-135784
DO - 10.1136/postgradmedj-2018-135784
M3 - Article
C2 - 30670487
AN - SCOPUS:85060368481
SN - 0032-5473
VL - 94
SP - 716
EP - 719
JO - Postgraduate Medical Journal
JF - Postgraduate Medical Journal
IS - 1118
ER -