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Teaching residents systems-based practice through a hospital cost-reduction program: a "win-win" situation
Robert Englander1, William Agostinucci, Edwin Zalneraiti
1Department of Pediatrics, University of Connecticut School of Medicine, Hartford, USA. Renglan@ccmckids.org
Background:
The Accreditation Council for Graduate Medical Education (ACGME) Outcome Project challenges residency programs to teach and evaluate competence in 6 domains, including systems-based practice (SBP). One element of SBP is to "practice cost-effective health care ... that does not compromise quality." Institutional cost-reduction efforts included targeting laboratory fees by using point-of-care testing with an iSTAT machine rather than in the central laboratory. Predicted cost savings were 50,000 US dollars per month. Because residents are primary users of laboratory resources, the authors engaged them in the process and implementation of system redesign.
Description:
The residents identified barriers to use of the iSTAT and solutions to overcome those barriers.
Evaluation:
As a result of resident solutions, use of the iSTATwent from 40% of potential iSTATtests being ordered on the iSTAT to 98%, with an estimated 549,780 US dollars per year in savings to the hospital.
Conclusion:
Involving residents in hospital cost-reduction efforts allows both teaching and evaluation of competence in SBP while realizing significant cost savings.
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