08 Feb Checklist Based Approach Reduced Unnecessary Blood Testing During Hospitalizations
MedicalResearch.com Interview with:
Dr. Peter Yarbrough
Peter M. Yarbrough MD
Department of Internal Medicine Division of General Internal Medicine
University of Utah Medical Center and
George E. Whalen Veteran Affairs Medical Center
Salt Lake City, Utah
Medical Research: What is the background for this study? What are the main findings?
Dr. Yarbrough: Waste is a major contributor to healthcare costs, accounting for an estimated $910 billion/year. Part of this waste includes unnecessary testing and routine laboratory testing has been recognized as frequently unnecessary for inpatients with an estimated 30-50% of tests not being needed. Through implementation of a multifaced quality improvement initiative including accurate cost feedback through the Value Driven Outcomes (VDO) the University of Utah Healthcare Internal Medicine hospitalist group was able to demonstrate a significant reduction in cost per day ($138 to $123) and cost per visit ($618 to $558) without adverse effect on length of stay or 30-day readmissions. A major component of the intervention included the use of a rounding checklist with discussion of tests required during rounds. Supporting that common laboratory tests were affected, the analysis showed a significant decrease in the number of BMP, CMP, and CBC tests per day compared to an institutional control. Estimated cost savings for this intervention were approximately $250,000 over the first year of the intervention.
Medical Research: What should clinicians and patients take away from your report?
Dr. Yarbrough: Clinicians are the major driver for ordering tests and we feel that reliable cost feedback and attention to waste in daily practice is important in helping to reduce waste in healthcare. This study supports previous studies that have demonstrated that reduction in laboratory tests does not come at the expense of good clinical care. We think that clinicians should consider standardized processes to address the common practice of routine ordering of tests and institutions should support reliable cost feedback through programs such as Value Driven Outcomes. And for patients, we hope that reduction in unnecessary testing can result in fewer awakenings for blood draws and less anemia.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Yarbrough: Our study looked broadly at laboratory use and encouraged senior resident or attending supervision of ordering, but did not attempt to determine what tests are necessary. This would be a very helpful area of future research. For while broad interventions can be helpful, it would also further this field to better understand which tests are both over and under ordered.
Additionally, this intervention was multifaceted and included 4 major components:
- education,
- cost feedback
- checklist use during rounds,
- and a cost-savings program.A major limitation of a multifaceted intervention is not knowing which component was most important in the project’s success. Future research could help delineate the most important components of quality improvement initiatives.
Citation:
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Peter M. Yarbrough MD (2016). Checklist Based Approach Reduced Unnecessary Blood Testing During Hospitalizations
Last Updated on February 8, 2016 by Marie Benz MD FAAD