High-Value, Cost-Conscious Care: Iterative Systems-Based Interventions to Reduce Unnecessary Laboratory Testing

Area of Science:

• Health Services Research
• Medical Economics
• Quality Improvement

Background:

• Inappropriate medical testing significantly increases US healthcare expenditures.
• Teaching hospitals often conduct tests for academic purposes, contributing to costs.
• The American Board of Internal Medicine's "Choosing Wisely" campaign advises against repetitive testing for stable inpatients.

Purpose of the Study:

• To implement and evaluate systems-based interventions aimed at reducing laboratory test orders for admitted patients at an academic medical facility.
• To address the financial burden of unnecessary diagnostic testing in a hospital setting.

Main Methods:

• Interventions focused on modifying the computer-based order entry system, specifically the automated admission order set and cost displays.
• A comparative study design was used, analyzing routine laboratory tests per inpatient day before and after interventions.
• Primary outcome was the reduction in routine tests per inpatient day; secondary outcomes included cost savings and patient safety events.

Main Results:

• The first intervention reduced laboratory tests by 19.4% (0.97 fewer tests per inpatient day).
• A subsequent intervention sustained the reduction, achieving 15.3% fewer tests.
• An estimated cost saving of $290,000 over two years was projected, with no increase in reported care delays or adverse events.

Conclusions:

• Systems-based interventions effectively reduced unnecessary laboratory testing in an academic hospital setting.
• The implemented changes led to significant cost savings without compromising clinical care or patient safety.
• Targeting electronic order entry systems offers a sustainable approach to controlling healthcare costs associated with diagnostic testing.