Multifaceted intervention including education, rounding checklist implementation, cost feedback, and financial incentives reduces inpatient laboratory costs. Issue 5 (4th February 2016) - Yarbrough, Peter M.
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. © 2016 Society of Hospital Medicine