Peter M Yarbrough1,2, Polina V Kukhareva3, Devin Horton1, Karli Edholm1, Kensaku Kawamoto3. 1. Department of Internal Medicine, Division of General Internal Medicine, University of Utah Medical Center, Salt Lake City, Utah. 2. Department of Internal Medicine, Division of General Medicine, George E. Whalen Veteran Affairs Medical Center, Salt Lake City, Utah. 3. Department of Biomedical Informatics, University of Utah, University of Utah Medical Center, Salt Lake City, Utah.
Abstract
BACKGROUND: Inappropriate laboratory testing is a contributor to waste in healthcare. OBJECTIVE: To evaluate the impact of a multifaceted laboratory reduction intervention on laboratory costs. DESIGN: A retrospective, controlled, interrupted time series (ITS) study. SETTING: University of Utah Health Care, a 500-bed academic medical center in Salt Lake City, Utah. POPULATION: All patients 18 years or older admitted to the hospital to a service other than obstetrics, rehabilitation, or psychiatry. INTERVENTION: Multifaceted quality-improvement initiative in a hospitalist service including education, process change, cost feedback, and financial incentive. MEASUREMENTS: Primary outcomes of lab cost per day and per visit. Secondary outcomes of number of basic metabolic panel (BMP), comprehensive metabolic panel (CMP), complete blood count (CBC), and prothrombin time/international normalized ratio tests per day; length of stay (LOS); and 30-day readmissions. RESULTS: A total of 6310 hospitalist patient visits (intervention group) were compared to 25,586 nonhospitalist visits (control group). Among the intervention group, the unadjusted mean cost per day was reduced from $138 before the intervention to $123 after the intervention (P < 0.001), and the unadjusted mean cost per visit decreased from $618 to $558 (P = 0.005). The ITS analysis showed significant reductions in cost per day, cost per visit, and the number of BMP, CMP, and CBC tests per day (P = 0.034, 0.02, <0.001, 0.004, and <0.001). LOS was unchanged and 30-day readmissions decreased in the intervention group. CONCLUSION: A multifaceted approach to laboratory reduction demonstrated a significant reduction in laboratory cost per day and per visit, as well as common tests per day at a major academic medical center. Journal of Hospital Medicine 2016;11:348-354.
BACKGROUND: Inappropriate laboratory testing is a contributor to waste in healthcare. OBJECTIVE: To evaluate the impact of a multifaceted laboratory reduction intervention on laboratory costs. DESIGN: A retrospective, controlled, interrupted time series (ITS) study. SETTING: University of Utah Health Care, a 500-bed academic medical center in Salt Lake City, Utah. POPULATION: All patients 18 years or older admitted to the hospital to a service other than obstetrics, rehabilitation, or psychiatry. INTERVENTION: Multifaceted quality-improvement initiative in a hospitalist service including education, process change, cost feedback, and financial incentive. MEASUREMENTS: Primary outcomes of lab cost per day and per visit. Secondary outcomes of number of basic metabolic panel (BMP), comprehensive metabolic panel (CMP), complete blood count (CBC), and prothrombin time/international normalized ratio tests per day; length of stay (LOS); and 30-day readmissions. RESULTS: A total of 6310 hospitalist patient visits (intervention group) were compared to 25,586 nonhospitalist visits (control group). Among the intervention group, the unadjusted mean cost per day was reduced from $138 before the intervention to $123 after the intervention (P < 0.001), and the unadjusted mean cost per visit decreased from $618 to $558 (P = 0.005). The ITS analysis showed significant reductions in cost per day, cost per visit, and the number of BMP, CMP, and CBC tests per day (P = 0.034, 0.02, <0.001, 0.004, and <0.001). LOS was unchanged and 30-day readmissions decreased in the intervention group. CONCLUSION: A multifaceted approach to laboratory reduction demonstrated a significant reduction in laboratory cost per day and per visit, as well as common tests per day at a major academic medical center. Journal of Hospital Medicine 2016;11:348-354.
Authors: Polina V Kukhareva; Charlene Weir; Guilherme Del Fiol; Gregory A Aarons; Teresa Y Taft; Chelsey R Schlechter; Thomas J Reese; Rebecca L Curran; Claude Nanjo; Damian Borbolla; Catherine J Staes; Keaton L Morgan; Heidi S Kramer; Carole H Stipelman; Julie H Shakib; Michael C Flynn; Kensaku Kawamoto Journal: J Biomed Inform Date: 2022-02-12 Impact factor: 6.317
Authors: Michelle P Debbink; Torri D Metz; Richard E Nelson; Sophie E Janes; Alexandra Kroes; Lori J Begaye; Cara C Heuser; Marcela C Smid; Robert M Silver; Michael W Varner; Brett D Einerson Journal: Am J Perinatol Date: 2021-12-02 Impact factor: 3.079
Authors: Renuka S Bindraban; Maarten J Ten Berg; Christiana A Naaktgeboren; Mark H H Kramer; Wouter W Van Solinge; Prabath W B Nanayakkara Journal: Ann Lab Med Date: 2018-09 Impact factor: 3.464
Authors: Andrew J Read; Akbar K Waljee; Jeremy B Sussman; Hardeep Singh; Grace Y Chen; Sandeep Vijan; Sameer D Saini Journal: JAMA Netw Open Date: 2021-10-01
Authors: Brett D Einerson; Richard E Nelson; Grecio Sandoval; M Sean Esplin; D Ware Branch; Torri D Metz; Robert M Silver; William A Grobman; Uma M Reddy; Michael Varner Journal: Obstet Gynecol Date: 2020-07 Impact factor: 7.623