SHM Converge Scientific Abstract ePoster Gallery-Reduction of Unnecessary Magnesium Laboratory Testing at Stanford Medical Center

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This project aimed to reduce unnecessary inpatient magnesium laboratory testing at Stanford University Hospital, using the Choosing Wisely principle of avoiding repetitive CBC and chemistry testing when patients and labs are stable. The team used Lean methodology to study current magnesium ordering practices, identify why low-value tests were being ordered, implement an intervention, and track results monthly.<br /><br />The hospital first reviewed historical magnesium test volumes and surveyed clinicians to understand ordering behavior. The biggest sources of unnecessary testing came from a small number of services, especially Cardiac Surgery, Cardiology, Hospital Medicine, Hematology, and BMT. Based on these findings, the team built an electronic health record intervention that limited recurrent sequential magnesium orders to a maximum of four tests within 48 hours. Clinician education accompanied the order changes.<br /><br />The study compared a pre-intervention period (April–September 2021) with a post-intervention period (October 2021–April 2022). After six months, magnesium testing decreased by 8% overall, and original magnesium lab orders dropped by 24%. Average monthly total tests fell from 19,244 to 17,725. Importantly, there were no significant changes in rapid response or code blue events, suggesting patient safety was not harmed. The intervention was estimated to save $67,801 in the first year.<br /><br />The authors concluded that changing order capabilities can meaningfully reduce test overuse and generate hospital-wide savings. However, implementation was complex because it affected many stakeholders and required major Epic EMR changes across inpatient, outpatient, perioperative, and infusion settings. Future plans include refining the intervention by embedding the new magnesium order into common order sets and extending similar strategies to other frequently overused labs such as CBCs and BMPs.

Asset Subtitle

Nicholas Scoulios

Meta Tag

Author List Benjamin Weia, David Svec, Lisa Shieh, Nicholas Scoulios, Yingjie Weng

Category Research

Concept Inpatient Magnesium Laboratory Testing

Concept Low-Value Care

Concept Lean Methodology

Concept Order Restriction

Concept Laboratory Utilization

Distinguished Non-Finalist

Presenter Organization Stanford University School of Medicine

Presenting Author Nicholas Scoulios

Track Quality Improvement

Keywords

magnesium testing

inpatient laboratory testing

Choosing Wisely

Lean methodology

electronic health record intervention

order set optimization

test overuse reduction

Stanford University Hospital

clinician education

healthcare cost savings

Inpatient Magnesium Laboratory Testing

Low-Value Care

Lean Methodology

Order Restriction

Laboratory Utilization