SHM Converge Scientific Abstract ePoster Gallery-Novel Best Practice Advisories to Reduce Unnecessary Testing

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This project addressed the problem of over-ordering repeat laboratory tests before the recommended retesting interval, which drives unnecessary costs and can contribute to provider burden. To reduce low-value testing while still giving clinicians useful information, the team created three Best Practice Advisory (BPA) pop-ups in the electronic medical record for Thyroid Stimulating Hormone (TSH), Erythrocyte Sedimentation Rate (ESR), and Hemoglobin A1c (HbA1c).<br /><br />The BPAs were active for inpatient and emergency department orders. If a repeat test was ordered too soon, the alert displayed the recommended interval, the most recent result, and the date of that result. The alerts were soft stops, meaning providers could continue only by documenting a reason. The team tracked how often each BPA fired and whether providers canceled the order. Cost savings were estimated using CMS billing practices.<br /><br />Results showed meaningful reductions in repeat testing. The HbA1c BPA fired 3,569 times, and providers canceled the order 73% of the time, saving an estimated $104,400. The TSH BPA fired 4,744 times, with a 54% cancellation rate and $72,260 saved. The ESR BPA fired 2,983 times, with a 39% cancellation rate and $11,730 saved. Total savings across the three interventions reached $188,390.<br /><br />The authors conclude that well-designed BPAs can improve clinical efficiency, reduce wasteful lab ordering, and lower patient costs by providing relevant information at the point of care. They are also surveying providers to understand whether the added workflow burden is justified by the benefits. Future plans include expanding BPAs to additional labs such as vitamin D, iron studies, ANA, hepatitis C antibody, and others.

Asset Subtitle

Stephan A. Castellanos

Meta Tag

Author List Amit Pahwa, Jessica Lin, Katie Anicich, Lenny Feldman, Pamela Johnson, Stephan A. Castellanos

Category Research

Concept Best Practice Advisory

Concept Repeat Laboratory Testing

Concept Laboratory Test Order

Concept Recommended Interval

Concept Thyroid-Stimulating Hormone

Distinguished Non-Finalist

Presenter Organization The Johns Hopkins Hospital

Presenting Author Stephan A. Castellanos

Track Value in Hospital Medicine

Keywords

repeat laboratory tests

Best Practice Advisory

electronic medical record

TSH

ESR

HbA1c

retesting interval

provider burden

cost savings

clinical efficiency

Best Practice Advisory

Repeat Laboratory Testing

Laboratory Test Order

Recommended Interval

Thyroid-Stimulating Hormone