Background: While multiple organizations have recommended reducing unnecessary and repetitive lab tests in hospitalized patients, this has not resulted in a widespread change in behavior. There is agreement that unwarranted labs increase costs, but data around specific lab costs have not been readily available. At baseline, there were 125,586 labs ordered by the UNC Rex Hospitalist team per year at an annual cost of $767,712.
Purpose: To reduce lab test utilization across the hospitalist team by sharing lab utilization data and providing cost transparency.
Description: In April 2019, the hospitalist team was shown data on individual lab ordering practices (number of labs per patient per day) and the associated cost (cost of labs per patient per day). This data was made transparent across the hospitalist team and pushed out on a biweekly basis by email. The team was provided education on the cost of specific labs as well as the total cost of labs per year. The team then set a goal to reduce their total cost of labs by 5%.The total monthly cost of labs decreased by 16% from $71,087 (January-March 2019) to $59,856 (April-August 2019) (figure 1), as the number of labs per patient per day decreased. When corrected for the census, the average cost of labs per patient per day decreased from $10.46 (January-March 2019) to $9.15 (April-August 2019), which is a 12.5% reduction (figure 2).
Conclusions: This intervention of simply providing data on utilization and cost quickly resulted in a behavioral change, thereby reducing lab test utilization and associated costs. One of the challenges in hospital medicine, however, is that patients are often cared for by multiple specialists at once. The next phase of this project involves applying the same intervention to other specialties while sustaining the behavioral change for the hospitalist team.
