SHM Converge Scientific Abstract ePoster Gallery-Improving Laboratory Utilization: A Quality Improvement Project

Pdf Summary

This quality improvement project aimed to reduce unnecessary routine morning laboratory testing on inpatient medicine teaching teams in the 4D and 6D nursing units at Englewood Hospital. The project was based on Choosing Wisely recommendations and concerns that repetitive labs increase costs, downstream testing, hospital-acquired anemia, and patient discomfort. The goal was to decrease routine lab ordering from 80% to 65% by May 2023.<br /><br />A pilot chart review was conducted from June to July 2022 using EPIC patient lists. Patients with hematologic malignancy or length of stay under 3 days were excluded. Surveys of hospitalists and residents helped identify resident teams as the main target for intervention. Several PDSA cycles were then implemented, including educational sessions for residents and attendings, hard stops in progress notes requiring justification for routine labs, email reminders, and posted signs on computers/documentation areas.<br /><br />From February to June 2023, repeat chart reviews tracked routine lab use, hemoglobin changes, 30-day readmissions, transfusions, discharge-day labs, and length of stay. In the pilot phase, routine lab use among residents was 80%. After interventions, the run chart showed a shift, with three data points falling below the 65% target. Although readmission data were incomplete because of technical issues, available data suggested a decrease from 16% to 7%.<br /><br />Overall, the project showed that repeated education and reminder systems successfully reduced routine lab ordering. The hard stop in progress notes was particularly helpful in prompting clinicians to justify lab orders. The authors noted improved resident behavior, with more clinically relevant labs being ordered. A limitation was incomplete readmission data, and results may have been influenced by increased resident knowledge over time.

Asset Subtitle

Doo Woong Choi

Meta Tag

Author List Aileen Tlamsa, Dipal R. Patel, Donjeta Sulaj, Doo Woong Choi, Hayder Al Khafaji, Marwa Elsheikh, Sofia Terner

Category Innovations

Concept Routine Laboratory Tests

Concept Quality Improvement

Concept Laboratory Stewardship

Concept Cost

Concept Downstream Testing

Distinguished Non-Finalist

Presenter Organization Englewood Hospital/Hackensack Meridian Health

Presenting Author Doo Woong Choi

Track Quality Improvement

Keywords

routine laboratory testing

quality improvement

Choosing Wisely

inpatient medicine

resident education

hard stop intervention

EPIC chart review

routine lab ordering

hospital-acquired anemia

Englewood Hospital

Routine Laboratory Tests

Quality Improvement

Laboratory Stewardship

Cost

Downstream Testing