Background: Misuse of laboratory tests can be difficult to determine unless tests are clearly overused or repeated routinely. However, excessive testing of chronically critically ill patients treated in long-term acute care hospitals (LTACHs) can be potentially harmful. A previously reported quality improvement initiative designed to increase physician awareness of their patterns of lab utilization in the LTACH environment resulted in LTACHs achieving significantly lower lab utilization without negatively impacting quality outcomes. The current study extended the time period and doubled the number of LTACHs participating to determine whether the results of the initiative were repeatable and sustainable.
Methods: Seventeen LTACHs with relatively high patterns of lab utilization within a large LTACH network participated in the initiative. Hospital administrative staff and physicians attended a session that included examination of their patterns of lab utilization, current literature on lab tests for CCI patients, and comparative lab utilization data from over 100 LTACHs. Each hospital staff independently designed and implemented hospital-specific strategies to address lab utilization (Table 1). Lab utilization was measured by the number of ordered units of lab tests (units) per inpatient day (UPPD) for 8 months prior to the initial meeting and 14 months after the meeting.
Results: A repeated measures mixed model revealed that postintervention lab utilization improved, on average and adjusted by case mix index, by 0.50 UPPD (t(16)=4.68, p < .001) compared to the preintervention period (Figure 1). Overall, the case mix index 8 months prior to the intervention was no different than it was 14 months after the initial meeting (t(16) = –1.53, P = 0.14). Patient safety and outcome measures, including the percentage of patients weaned from a ventilator, readmission rates, central catheter utilization rates, and the incidence of methicillin-resistant Staphylococcus aureus and other multidrug resistant organisms, showed no significant change, with the exception of a significant decrease in central line associated bloodstream infection rates, notably occurring after reduced line handling for the purposes of labs.
Conclusions: Hospital staff meetings focused on lab utilization and the development and implementation of tailored lab utilization strategies were associated with LTACHs achieving sustainable, significantly lower lab utilization without negatively impacting quality outcomes.
