SHM Converge Scientific Abstract ePoster Gallery-Reducing Routine Venous Blood Gases: A Resident-Led Qi Project at a Safety Net Hospital

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This resident-led quality improvement project at a safety-net hospital aimed to reduce unnecessary morning venous blood gas (VBG) orders on general medicine wards. VBGs are useful for critically ill patients, but routine use in non-critically ill inpatients can delay lab processing and produce inaccurate results, potentially leading to unnecessary testing or incorrect interventions.<br /><br />The team tracked morning VBG orders from May 2023 to April 2024, focusing on draws between 4 AM and 8 AM because these occur during peak laboratory workload. They also surveyed internal medicine residents to understand why they ordered VBGs and whether they knew that lactate requires a separate plasma order and that nurses, not phlebotomists, draw VBGs at this hospital.<br /><br />The survey had a 65% response rate. Most residents ordered VBGs to assess pH, pCO2, and lactate. Many were unaware of the separate blood draw process, and over one-third did not know lactate needed a separate order.<br /><br />Interventions included three brief educational sessions reviewing the survey findings, appropriate indications for VBGs, and the biochemical reasons for inaccurate results. This was followed by a humorous “Cut the Crap” awareness campaign using posters and prizes to reinforce the message.<br /><br />The project achieved a 67% reduction in morning VBGs, dropping from 8.2 to 2.7 per day, and this improvement was sustained for more than six months. Because the change persisted, the team did not proceed with additional EMR-based interventions.<br /><br />The authors conclude that even educational interventions can produce durable improvement when they increase awareness of harm, emphasize patient impact, and use memorable messaging. They expect benefits including less patient discomfort, lower costs, reduced lab workload, and improved VBG accuracy.

Asset Subtitle

Simrat K. Batth

Meta Tag

Author List Hannah Hugo, Jesus Javier Rubio Castillon, Julie Kanevsky, Simrat K. Batth, Thaina Rousseau Pierre

Category Innovations

Concept Venous Blood Gas Analysis

Concept Quality Improvement

Concept Accuracy

Concept Hospitalized Patient

Concept Blood Gas Processing

Distinguished Non-Finalist

Presenter Organization Icahn School of Medicine at Mount Sinai Elmhurst Hospital Center NYC H+H

Presenting Author Simrat K. Batth

Track Quality Improvement

Keywords

resident-led quality improvement

morning VBG orders

venous blood gas

general medicine wards

safety-net hospital

educational intervention

laboratory workflow

lactate order

survey of residents

quality improvement campaign

Venous Blood Gas Analysis

Quality Improvement

Accuracy

Hospitalized Patient

Blood Gas Processing