Background: Excessive laboratory use has been associated with increased hospital costs, increased incidence of anemia, and unnecessary additional testing and procedures. Previous studies have focused on resident interventions within teaching hospitals amongst other residents, but few studies have had residents intervene on non-teaching faculty. A quality improvement initiative was implemented at our institution to reduce the number of laboratory tests ordered at a private hospital in Texas by 3% over the course of 14 weeks through the combination of frequent email reminders and evidence-based literature.
Methods: Our intervention was conducted between November 2022 and February 2023 at a private institution in Texas. Residents generated evidence-based emails sent weekly to biweekly to the hospitalist group on why certain laboratory testing was not clinically useful daily or in general. The laboratory tests included Thyroid Stimulating Hormone (TSH), Folic Acid, Phosphorous, Vitamin D, Complete Blood Count (CBC) and Basic Metabolic Panel (BMP). Data collection was done weekly and the outcome measure was aggregate common labs (defined as CBC, BMP, Comprehensive Metabolic Panel, TSH, Arterial Blood Gas, Hemoglobin/Hematocrit, Magnesium, Phosphorous, Potassium, Prothrombin Time/Partial Thromboplastin Time/International Normalized Ratio and Hemoglobin A1C) per hospital encounter. TSH and phosphorous ordered per encounter were used as process measures. Length of stay and hospital readmission rates were tracked as balancing measures.
Results: During the 14-week intervention, there was a reduction in aggregate labs by 5%, phosphorous labs by 20%, and TSH labs by 17%, resulting in an estimated $70,225 in savings. The U charts shown in Fig. 1 demonstrated shifts in aggregate and phosphorous labs but not in TSH labs. Length of stay and thirty-day readmission rates did not demonstrate shifts post-intervention, as shown in Fig. 2. Following the study period, aggregate lab utilization returned to baseline.
Conclusions: This study demonstrates that educational interventions by residents can impact lab utilization by hospitalists, but results do not appear to be sustainable. Laboratory utilization remains a significant opportunity for costs savings without apparent impact on length of stay and readmission rates. Further studies are needed to better understand which aspect of the emails were most effective to elicit change. Multipronged approaches are likely needed to obtain sustainable lab utilization changes.
