SHM Converge Scientific Abstract ePoster Gallery-Leveraging the Electronic Medical Record to Assist With Laboratory Stewardship

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This study describes a hospital system-wide effort to reduce low-value inpatient laboratory testing through an electronic medical record (EMR) intervention. Rising healthcare costs and high use of daily labs such as CBC, BMP, and CMP prompted a multidisciplinary team including clinical leadership, IT, hospital medicine, and laboratory services to act. After discussion with frontline staff, the team changed the EMR so standing daily lab orders could only be placed for a maximum of 3 days and then had to be renewed if still clinically necessary. This limit was chosen because the institution’s average length of stay is about 4 days. ICU-related coagulation tests (PT, PTT, INR) were excluded due to concerns about patient safety, especially for ECMO patients.<br /><br />The intervention was implemented across four hospitals on September 12, 2023, with education provided to inpatient teams. The team analyzed orders for BMP, CBC, magnesium, phosphate, CMP, PT, liver panel, PTT, and procalcitonin. They compared 19 weeks of baseline data with 8 weeks after implementation and also monitored for adverse events through the event reporting system.<br /><br />Results showed a statistically significant reduction in lab use after the change. Median weekly tests decreased from 14,323 to 13,476, a reduction of 847 tests per week. Median tests per patient per week also dropped from 8.42 to 7.84, both with p-values of 0.01. Declines were seen in CBC, BMP, CMP, liver panel, magnesium, and phosphorus, while PT and PTT remained unchanged as expected. No adverse events or care delays were reported.<br /><br />The authors conclude that EMR-based ordering limits, combined with frontline buy-in, can improve laboratory stewardship safely. They plan longer-term follow-up and cost analyses.

Asset Subtitle

Alya Ahsan

Meta Tag

Author List Alya Ahsan, Elizabeth Thorn, Erin Proctor, Karen Kaul, Osasumwen Osayimwen, Patrick McNulty, Robert Benirschke, Shilpan Patel

Category Research

Concept Shared Electronic Medical Record Results Pool

Concept Inpatient Laboratory Testing

Concept Daily Laboratory Orders

Concept Order Duration

Concept Laboratory Stewardship

Distinguished Non-Finalist

Presenter Organization Endeavor Health

Presenting Author Alya Ahsan

Track Technology in Hospital Medicine

Keywords

laboratory stewardship

EMR intervention

inpatient testing

daily lab orders

CBC

BMP

CMP

patient safety

order limit

cost reduction

Shared Electronic Medical Record Results Pool

Inpatient Laboratory Testing

Daily Laboratory Orders

Order Duration

Laboratory Stewardship