A multifaceted quality improvement approach targeting superfluous laboratory services at a Utah academic medical center was able to reduce inpatient lab costs on a daily and per-visit basis.
An article describing the study’s results, “Multifaceted Intervention Including Education, Rounding Checklist Implementation, Cost Feedback, and Financial Incentives Reduces Inpatient Laboratory Costs,” was published in the Journal of Hospital Medicine.
The United States spends more than $910 billion annually on healthcare waste. “Laboratory tests are well documented to contribute to healthcare waste, with an estimated 30% to 50% of tests for hospitalized patients being unnecessary,” according to the study’s authors. This isn’t just a cost issue, the study’s authors emphasize. Excessive tests leading to false positives and retests also pose safety concerns for patients.
“Frequently, patients do need labs every morning, but that can create a culture where you’re ordering tests without really thinking about what you’re going to do with the results,” said Peter Yarbrough, MD, the study’s lead author, in a statement.
The study took place over a 15-month period at University of Utah Health Care academic medical center in Salt Lake City, and included patients over the age of 18 seeking hospital care that excluded obstetrics, rehabilitation, or psychiatry services.
Yarbrough, an assistant professor of internal medicine who practices at the VA Salt Lake City Health Care System, and his co-researchers used a newly developed tool from the university, “Value Driven Outcomes (VDO),” to gauge actual cost data on patient care and enact a multifaceted quality improvement initiative in the hospitalist environment. The study’s authors, in using VBO, discovered that University Hospital was spending $2 million a year alone in lab testing on patients hospitalists care for.
The strategy the investigators developed incorporated a number of interventions: educating providers on laboratory overuse and costs; standardizing the rounding process to include a patient checklist review; a financial incentives program, and using VDO as a monthly feedback mechanism during hospitalist group meetings. “Data were presented as a monthly group average and compared to preintervention baseline costs. Individual performance could be viewed and compared to other providers within the group,” the authors explained.
The study’s investigators, in comparing an intervention group of 6,310 hospitalist visits with a control group of 25,586 nonhospitalist visits, found that the interventions significantly reduced the number of tests ordered, subsequently reducing daily lab costs. In the intervention group, mean costs per day for laboratory testing decreased from $138 to $123 and mean costs per visit dropped from $618 to $558.
The researchers also observed reductions in the number of 30-day readmissions and daily orders of basic metabolic panel, comprehensive metabolic panel, complete blood count, and prothrombin time/international normalized ratio tests.
The study’s authors estimated that the hospital could save more than $1.5 million annually if all inpatient visits were handled under this interventional strategy.
“As we look at how we can conserve our resources as a nation and improve the value that we provide with health care, it’s imperative for us to help get professionals in health care systems to be good stewards of resources and to avoid unnecessary diagnostics and interventions,” said Kensaku Kawamoto, MD, PhD, MHS, a senior author of the study, and assistant professor of biomedical informatics at the University of Utah Health Sciences Center.