SHM Converge Scientific Abstract ePoster Gallery-Prevalence of Lab-Ordering for Patients Discharged to SNF

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This study examined how often daily labs (DL) and discharge-day labs (LOD) were ordered for hospitalized patients discharged to skilled nursing facilities (SNFs), where non-medical delays may increase unnecessary testing. Researchers reviewed ordering data from two direct-care services staffed by an attending hospitalist and a third-year internal medicine resident. The main outcome was whether patients had daily BMP and/or CBC labs throughout hospitalization, including the discharge day. They also used bivariate and multivariate logistic regression to see whether lab ordering differed by provider or hospitalization characteristics.<br /><br />Among 165 patients discharged to SNFs, 91% had daily labs and 73% had labs ordered on the day of discharge. In bivariate analysis, there were no significant differences in LOD based on provider characteristics such as whether the patient was staffed by an attending hospitalist or resident, the hospitalist’s gender, or years of experience. However, higher-acuity hospitalization features were associated with more LOD. Patients who had an ICU stay had a higher prevalence of LOD than those without ICU stay (94% vs. 71%), and patients on subspecialty services also had more LOD than general medicine patients (100% vs. 70%). In multivariable analysis, no single factor was statistically significant, although ICU stay was associated with about seven times higher odds of LOD.<br /><br />The authors concluded that use of daily and discharge-day labs was high in patients discharged to SNFs, especially among patients with greater illness severity. They recommend broad interventions to reduce unnecessary lab testing in this population and suggest future work to determine whether these discharge-day labs are clinically appropriate.

Asset Subtitle

Nicole Gras

Meta Tag

Author List Matthew T. Cerasale, Nicole Gras, Rebecca L. Wilson, Shannon K. Martin

Category Research

Concept Laboratory Test

Concept Skilled Nursing Facility

Concept Iatrogenic Anemia

Concept Primary Outcome

Concept Laboratory Ordering

Distinguished Non-Finalist

Presenter Organization University of Chicago

Presenting Author Nicole Gras

Track Quality Improvement

Keywords

daily labs

discharge-day labs

skilled nursing facilities

hospitalized patients

laboratory testing

BMP

CBC

hospitalist

ICU stay

logistic regression

Laboratory Test

Skilled Nursing Facility

Iatrogenic Anemia

Primary Outcome

Laboratory Ordering