Background: Ten to twenty percent of U.S. hospitalizations are avoidable, driven by clinical uncertainty, social factors, or lack of access to ambulatory care [1-3]. These unnecessary admissions result in significant human and financial costs, including in-hospital errors, wasteful spending, and medical debt [4-7]. With hospital occupancy reaching critical levels, we designed and launched the Olive [...]

Background: The American Board of Internal Medicine and the Society of Hospital Medicine have identified routine laboratory testing of stable inpatients as one source of low-value care.1,2 As it is estimated that upwards of 21% of all lab tests represent inappropriate overutilization,3 reducing unnecessary testing could have a significant impact on cost saving, limiting waste, [...]

Background: Cardiac monitoring (CM) is often overused, hindering patient mobility, triggering unnecessary cardiac testing, delaying appropriate discharge, and expending resources.  Purpose: To reduce the days that medical and surgical ward patients spend on CM without an indication specified in the 2004 American Heart Association (AHA) guidelines for CM.  Description: At Cedars-Sinai, only 59% of patients [...]

Background: Up to 50% of the American healthcare spending is estimated to be wasteful. The largest type of wasteful spending is on overuse of tests and treatments. Among the diagnostic tests that are overused, excessive phlebotomy stands out due to its multifaceted implications, including hospital-acquired anemia, patient discomfort, provider burden, and avoidable downstream testing. The [...]

Background: The Society of Hospital Medicine’s Choosing Wisely recommendations include avoiding repetitive Complete blood count (CBC) and serum electrolyte panels (SEPs). SEPs include basic and comprehensive metabolic panels (BMP, CMP respectively). Unnecessary routine lab can cause increased costs(1)(2), unnecessary downstream testing and procedures, hospital acquired anemia(2)(3)(4) and patient discomfort. Multiple QI project has been successful [...]

Background: Cost associated with diagnostic testing contributes greatly to the rising cost of health care in the United States (Bindraban et al, 2018). There is evidence to suggest that up to 20% of lab testing is unnecessary (Bindraban et al, 2018).Main Line Health (MLH) is a health system in suburban Philadelphia made up of four [...]

Background: Ten to twenty percent of U.S. hospitalizations are avoidable, driven by clinical uncertainty, social factors, or lack of access to ambulatory care [1-3]. These unnecessary admissions result in significant human and financial costs, including in-hospital errors, wasteful spending, and medical debt [4-7]. With hospital occupancy reaching critical levels, we designed and launched the Olive [...]

Background: Discharge planning plays a critical role in managing hospital length of stay (1). We report on the implementation of a program in a large hospital system where health care providers were requested to estimate and record the Medically Ready for Discharge Date (MRDD) in the electronic health record (EHR) for hospitalized patients to facilitate [...]

Background: Inpatient telemetry monitoring is a limited resource. The value of telemetry monitoring in hospitalized patients with high risk for cardiac arrhythmia is high. However, telemetry monitoring is often ordered for inpatients at low risk for cardiac arrhythmia. The SHM’s Choosing Wisely campaign recommended avoiding continuous telemetry monitoring in non-ICU patients without a protocol. Ordering [...]

Background: Nearly one-third of laboratory tests in hospitalized patients and up to 60% of routine, repeat lab tests are unnecessary. Unnecessary testing results in excess venipuncture, iatrogenic anemia, patient discomfort, excess costs, wasted lab resources, and a potential cascade of additional tests and interventions. Few academic medical centers, including our institution, have systematic lab stewardship [...]