SHM Converge Scientific Abstract ePoster Gallery-Establishing a Lab Stewardship Program to Reduce Lab Overutilization

Pdf Summary

The document describes the development of a comprehensive laboratory stewardship program aimed at reducing unnecessary lab testing, lowering costs, and improving patient care. The authors note that a substantial share of inpatient lab tests—especially routine repeat tests—are unnecessary and can cause iatrogenic anemia, waste resources, and increase expenses. Because isolated quality improvement efforts tend not to last, the team sought a sustainable, system-wide approach.<br /><br />To design the program, they reviewed lab test volume, cost, evidence-based and value-based care guidelines, and the likelihood that clinical decision support could successfully reduce overuse. Based on this assessment, they chose two pilot targets for year one: CBC with differential and prealbumin. They also created a multidisciplinary governance committee with expertise in laboratory medicine, hospital medicine, informatics, quality improvement, and change management, supported by executive leadership.<br /><br />Their stewardship framework included three main strategies: stakeholder engagement, educational outreach, and EHR-based interventions. Stakeholders such as clinical nutrition and hematology/oncology helped ensure changes were clinically appropriate and minimally disruptive. The educational campaign included more than 25 presentations, posters, newsletters, and system-wide computer screensavers. EHR modifications included a best practice advisory encouraging switch from CBC with differential to CBC without differential for frequent daily ordering when prior results were normal, and embedded guidance discouraging inpatient prealbumin use for malnutrition assessment, with required acknowledgment to proceed.<br /><br />Overall, the program was designed to support measurement, feedback, and iterative improvement, while creating a scalable framework for expanding lab stewardship to additional tests in the future.

Asset Subtitle

Theodore Peng

Meta Tag

Author List Amy Lu, Andrew D. Auerbach, Anoop N. Muniyappa, Armond Esmaili, Brandon S. Scott, Cait Richards, Catherine Y. Lau, Janelle Lee, Parul Bhargava, Sajan Patel, Theodore Peng

Category Innovations

Concept Laboratory Stewardship

Concept Inpatient Laboratory Testing

Concept Complete Blood Count with Differential

Concept Prealbumin

Concept Overuse

Distinguished Non-Finalist

Presenter Organization University of California San Francisco

Presenting Author Theodore Peng

Track Value in Hospital Medicine

Keywords

laboratory stewardship

unnecessary lab testing

CBC with differential

prealbumin

clinical decision support

electronic health record

iatrogenic anemia

cost reduction

quality improvement

inpatient lab utilization

Laboratory Stewardship

Inpatient Laboratory Testing

Complete Blood Count with Differential

Prealbumin

Overuse