Clinical question: Can a multifaceted intervention decrease the frequency of unnecessary labs?
Background: Implementation of a multifaceted QI intervention within a large, community-based hospitalist group to decrease ordering of common labs.
Study design: QI project.
Setting: Large, community-based hospitalist group.
Synopsis: QI intervention was composed of academic detailing, audit and feedback, and transparent reporting of the frequency with which common labs were ordered daily. Researchers performed a pre-post analysis, comparing a cohort of patients during the 10-month baseline period before the QI intervention and the seven-month intervention period. The baseline (n=7,824) and intervention (n=5,759) cohorts were similar in their demographics.
Adjusting for age, sex, and principle discharge diagnosis, the number of common labs ordered per patient-day decreased by 0.22 (10.7%) during the intervention period compared with baseline (95% confidence interval [CI], 0.34 to 0.11; P<0.01). No effect was seen on length of stay or readmission rate. The intervention decreased hospital direct costs by an estimated $16.19 per admission or $151,682 annualized (95% CI, $119,746 to $187,618).
Bottom line: A community-based, hospitalist-led, QI intervention focused on daily labs can be effective in safely reducing healthcare waste without compromising quality of care.
Citation: Corson AH, Fan VS, White T, et al. A multifaceted hospitalist quality improvement intervention: decreased frequency of common labs. J Hosp Med. 2015;10(6):390-395.