SHM Converge Scientific Abstract ePoster Gallery-Reducing Low-Value Cbcs: Audit and Feedback Using Resident-Defined Standards

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This study evaluated whether an audit-and-feedback intervention could reduce low-value inpatient lab testing. Repetitive blood draws can cause discomfort, iatrogenic anemia, sleep disruption, and strain lab staff, especially when patients repeatedly decline phlebotomy.<br /><br />Using a modified Delphi process, medical residents defined criteria for “stable” CBCs and chemistry panels. Residents then received weekly feedback comparing their daily ordering patterns with those of their peers. The team tracked both total labs ordered and labs ordered despite meeting stability criteria.<br /><br />The intervention was associated with a sustained reduction in unnecessary CBC ordering. CBCs ordered despite stability fell from 0.0679 to 0.0481 per patient-day, and total CBCs per patient-day also decreased from 0.420 to 0.363, both statistically significant. On an average census of 64 medicine inpatients, this translated to roughly 25 CBCs avoided per week. In contrast, chemistry panel ordering did not meaningfully change, likely because electrolytes and renal function often require close monitoring for reasons beyond lab stability.<br /><br />Patient-declined labs decreased from 89 per month before the intervention to 43 per month in the six months afterward. The authors suggest this may reflect fewer repeated blood draws and/or improved communication about daily testing.<br /><br />Overall, the study concludes that an audit-and-feedback approach based on resident-defined laboratory stability criteria can safely and sustainably reduce likely unnecessary CBC ordering in hospitalized patients.

Asset Subtitle

Ryan Duffy

Meta Tag

Author List Alex Linares, Brian Schneider, David Simel, Joel Boggan, Ryan Duffy, Suchita Sata

Category Research

Concept Inpatient Laboratory Testing

Concept Resident Physician

Concept Audit and Feedback

Concept Unnecessary Testing

Concept Clinical Stability

Distinguished Non-Finalist

Presenter Organization Durham VA Medical Center

Presenting Author Ryan Duffy

Track Quality Improvement

Keywords

audit-and-feedback

low-value testing

CBC ordering

inpatient labs

resident feedback

laboratory stability criteria

unnecessary blood draws

patient-declined labs

iatrogenic anemia

chemistry panels

Inpatient Laboratory Testing

Resident Physician

Audit and Feedback

Unnecessary Testing

Clinical Stability