David P Johnson1, Carrie Lind2, Sarah E S Parker2, Christian Beuschel3, Stacey VanVliet3, James Nichols4, Carol A Rauch4, Brenda Lee5, Stephen E Muething5. 1. Departments of Pediatrics, Division of Hospital Medicine, and david.p.johnson.1@vanderbilt.edu. 2. Departments of Pediatrics, Division of Hospital Medicine, and. 3. Pediatric Residency Program, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee; 4. Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee; and. 5. Cincinnati Children's Medical Center, Cincinnati, Ohio.
Abstract
OBJECTIVE: Achieving high-value health care is a goal of health care providers who strive to increase quality and decrease cost. Decreasing laboratory tests is a potential method to increase value. We used quality improvement methodology to decrease the percentage of unnecessary complete blood counts (CBCs) and basic metabolic panels (BMPs) obtained on a pediatric hospital medicine service from 13.5% to <5%. METHODS: A pre- and postintervention design was conducted including all patients admitted to 2 hospital medicine teams between May 2013 and December 2014. Multiple interventions linked to key drivers were tested through rapid plan-do-study-act cycles. Primary and secondary outcome measures, percent reduction of unnecessary CBCs and BMPs, and consecutive day tests were analyzed using statistical process control. Total billed charges, laboratory charges, 7-day readmission rates, and length of stay were compared pre- and postintervention. RESULTS: Primary outcome of unnecessary CBCs and BMPs was reduced from a baseline of 13.5% to 4.5%. Secondary outcome measure of consecutive day testing was reduced from 20.9% to 8.5%. Median laboratory charges decreased significantly ($842 [$256-$1863] vs $800 [$222-$1616], P = .002), with no significant differences in total billed charges, 7-day readmission rates, or length of stay. CONCLUSIONS: Rapid cycle plan-do-study-act methodology, initially focusing on the inclusion of a daily laboratory plan in progress notes, was an effective means to improve laboratory utilization and decrease laboratory charges without adversely affecting other quality measures. Spreading these efforts to different patient populations and laboratory tests could have a demonstrable effect on the value of health care.
OBJECTIVE: Achieving high-value health care is a goal of health care providers who strive to increase quality and decrease cost. Decreasing laboratory tests is a potential method to increase value. We used quality improvement methodology to decrease the percentage of unnecessary complete blood counts (CBCs) and basic metabolic panels (BMPs) obtained on a pediatric hospital medicine service from 13.5% to <5%. METHODS: A pre- and postintervention design was conducted including all patients admitted to 2 hospital medicine teams between May 2013 and December 2014. Multiple interventions linked to key drivers were tested through rapid plan-do-study-act cycles. Primary and secondary outcome measures, percent reduction of unnecessary CBCs and BMPs, and consecutive day tests were analyzed using statistical process control. Total billed charges, laboratory charges, 7-day readmission rates, and length of stay were compared pre- and postintervention. RESULTS: Primary outcome of unnecessary CBCs and BMPs was reduced from a baseline of 13.5% to 4.5%. Secondary outcome measure of consecutive day testing was reduced from 20.9% to 8.5%. Median laboratory charges decreased significantly ($842 [$256-$1863] vs $800 [$222-$1616], P = .002), with no significant differences in total billed charges, 7-day readmission rates, or length of stay. CONCLUSIONS: Rapid cycle plan-do-study-act methodology, initially focusing on the inclusion of a daily laboratory plan in progress notes, was an effective means to improve laboratory utilization and decrease laboratory charges without adversely affecting other quality measures. Spreading these efforts to different patient populations and laboratory tests could have a demonstrable effect on the value of health care.
Authors: Derek J Williams; Matthew Hall; Jeffrey S Gerber; Mark I Neuman; Adam L Hersh; Thomas V Brogan; Kavita Parikh; Sanjay Mahant; Anne J Blaschke; Samir S Shah; Carlos G Grijalva Journal: Pediatrics Date: 2017-03-08 Impact factor: 7.124
Authors: Michael J Tchou; Matt Hall; Samir S Shah; David P Johnson; Alan R Schroeder; James W Antoon; Marquita C Genies; Ricardo Quinonez; Christopher W Miller; Snehal P Shah; Patrick W Brady Journal: Pediatrics Date: 2019-06-06 Impact factor: 9.703
Authors: Nedra S Whitehead; Laurina O Williams; Sreelatha Meleth; Sara M Kennedy; Nneka Ubaka-Blackmoore; Sharon M Geaghan; James H Nichols; Patrick Carroll; Michael T McEvoy; Julie Gayken; Dennis J Ernst; Christine Litwin; Paul Epner; Jennifer Taylor; Mark L Graber Journal: Crit Care Date: 2019-08-09 Impact factor: 9.097