SHM Converge Scientific Abstract ePoster Gallery-Reducing Lab Overuse for Patients Awaiting Facility Placement

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This quality improvement project examined inappropriate daily lab ordering for hospitalized patients discharged to skilled nursing facilities, a group that often waits several extra days before placement and may therefore receive unnecessary blood draws. The study was conducted on general medicine and cardiology teaching services at an urban academic tertiary medical center.<br /><br />The background for the project was the high cost of healthcare and the known harms of excessive inpatient laboratory testing, including increased expenses, iatrogenic anemia, patient discomfort, and strain on phlebotomy resources. The team focused on daily labs, defined as BMP, CBC, or both ordered every day of hospitalization, and also on labs drawn on the day of discharge. Appropriateness was assessed by physician chart review using agreed-upon guidelines to reduce subjectivity.<br /><br />A retrospective baseline review was performed for patients discharged to SNFs from February 2021 through January 2022. After baseline analysis, several educational interventions were introduced: emails to providers emphasizing lab stewardship, posters in workrooms reminding teams to avoid daily labs in patients awaiting SNF placement, and a resident lecture with case review and distribution of lab appropriateness guidelines. Post-intervention data from February 2022 through October 2022 were then reviewed in the same way.<br /><br />The intervention phase did not significantly reduce inappropriate daily lab draws or discharge-day lab testing. One major confounder was resident turnover, with new PGY3s replacing more experienced residents in July. The team plans to add electronic health record prompts and provider feedback in future phases.<br /><br />Overall, the project concluded that lab overuse remains a problem at the institution and that education alone was insufficient to change ordering behavior.

Asset Subtitle

Rebecca L. Wilson

Meta Tag

Author List Arti Tewari, Caleb Murphy, Ethan Molitch-Hou, Matthew T. Cerasale, Nicole Gras, Rebecca L. Wilson, Shannon K. Martin

Category Innovations

Concept Inpatient Lab Overutilization

Concept Iatrogenic Anemia

Concept Routine Laboratory Draws

Concept Educational Intervention

Concept Laboratory Test

Distinguished Non-Finalist

Presenter Organization University of Chicago Section of Hospital Medicine

Presenting Author Rebecca L. Wilson

Track Quality Improvement

Keywords

inappropriate lab ordering

daily lab tests

skilled nursing facility

hospitalized patients

lab stewardship

quality improvement

discharge-day labs

iatrogenic anemia

resident education

electronic health record prompts

Inpatient Lab Overutilization

Iatrogenic Anemia

Routine Laboratory Draws

Educational Intervention

Laboratory Test