SHM Converge Scientific Abstract ePoster Gallery-Comparing Prompting Strategies to Reduce Lab Utilization Among Medicine Residents

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This study examined whether two different reminder styles could reduce unnecessary daily lab testing—specifically complete blood counts (CBCs) and serum electrolyte panels (SEPs)—on internal medicine teaching services at a large county hospital. The rationale was that repeated lab testing can contribute to anemia, poor sleep, and higher costs, especially in resource-limited settings.<br /><br />Three inpatient teaching teams were randomly assigned to one of three arms: Education-Oriented prompts, Action-Oriented prompts, or control. Both intervention groups received weekly verbal reminders from attendings and every-other-week text reminders from the study team. The educational prompts focused on the harms of unnecessary testing, while the action prompts gave practical steps to reduce lab ordering. The main outcome was the average number of CBCs and SEPs ordered per patient day per encounter, compared with three months of pre-intervention data.<br /><br />In this preliminary unadjusted analysis, the Action-Oriented prompt group showed a modest reduction in daily lab utilization, decreasing from 2.11 to 1.98 labs per patient day. The Education-Oriented group increased slightly from 2.10 to 2.19, and the control group increased from 2.04 to 2.14. However, none of these changes reached statistical significance.<br /><br />The authors conclude that action-based prompts may be more effective than education-only reminders, but the findings are not definitive. Important limitations included a single-site design, incomplete blinding, study disruption, and the preliminary nature of the analysis. Next steps include data cleaning and adjusted analysis, with future work aimed at integrating the findings into clinical decision support and high-value care education, and testing the approach across multiple sites.

Asset Subtitle

Vishvaas I. Ravikumar

Meta Tag

Author List Andrew W. Schram, Caleb J. Murphy MD, MBA, Courtney L. Thornton, Justin S. Bauzon MD, Sandhya Wahi-Gururaj MD, MPH, Vishvaas I. Ravikumar

Category Research

Concept Blood Count

Concept Serum Electrolyte Panel

Concept Low-Value Care

Concept Randomization

Concept Primary Outcome Measure

Distinguished Non-Finalist

Presenter Organization Department of Medicine, Oregon Health and Science University

Presenting Author Vishvaas I. Ravikumar

Track Quality Improvement

Keywords

lab testing

CBC

serum electrolyte panels

reminder prompts

action-oriented intervention

education-oriented intervention

hospital medicine

high-value care

randomized trial

clinical decision support

Blood Count

Serum Electrolyte Panel

Low-Value Care

Randomization

Primary Outcome Measure