A quality improvement (QI) initiative can start with a single hospitalist, says Adam H. Corson, MD, a hospitalist at Seattle’s Swedish Medical Center.
In a study presented at SHM's annual meeting, Dr. Corson set out to determine whether critically evaluating how frequently common lab tests were ordered could help decrease hospital costs. Using a cohort of patients, Dr. Corson compared how often a complete blood count or a metabolic panel was ordered in a large hospitalist group. His QI intervention involved academic detailing, audit, and feedback, as well as transparent reporting of lab orders for 9,368 patients. At baseline, a mean of 2.06 common labs were ordered per patient day. The number of labs ordered post-intervention decreased by 10%.
“Within the hospitalist team itself, there was a 20% reduction,” Dr. Corson says. That percentage “got diluted down to 10% when you included all the other providers who care for a patient.” He found no adverse effects from this intervention on mortality, length-of-stay, or readmission rates. His report also cited a reduction in the volume of blood transfused per patient who received a transfusion and a $16.19 decrease in hospital costs—a total of $159,682—per admission annualized for the cohort.
Although better patient care was his main goal, a secondary goal was to demonstrate the potential value of hospitalists in today’s changing medical environment, particularly in terms of reimbursement. “In a fee-for-service world, hospitalists can’t participate as much as [physicians in] other areas of medicine,” he says. “But in a fee-for-outcome world, hospitalists can play a big role, and this is a demonstration of that.”
He also points out that this cost-effective intervention was basically done by him alone, “one hospitalist with access to electronic medical records and someone to pull some data out of there.”
Dr. Corson says he hopes his study will inspire other providers to look at this specific topic in their own practice and possibly expand it to other services they order each day. “The big headline these days is the United States spends more money on healthcare than everyone else does, but we don’t get better results,” he says. “Inherent in that is the idea that we do a lot of stuff that doesn’t need to be done or has no physical value. This is a small example of that.” TH