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Quality Improvement Intervention for Reduction of Redundant Testing.

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|July 21, 2017
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Summary

Implementing computerized order entry with peer feedback significantly improved cardiac marker test guideline compliance. This led to sustained improvements and substantial cost savings, demonstrating effective pathology leadership in optimizing laboratory test utilization.

Keywords:
creatine kinase MB formdecision support techniquesinterrupted time series analysismyocardial infarctionpathologistspatient safetyquality improvement

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Area of Science:

  • Clinical Pathology
  • Health Services Research
  • Medical Informatics

Background:

  • Laboratory data are crucial for clinical quality assessment and improvement.
  • Routine creatine kinase and isoenzyme testing for myocardial infarction is being re-evaluated.
  • Clinician concerns exist regarding potential loss of sensitivity with test discontinuation.

Purpose of the Study:

  • To assess disease outcomes of discordant creatine kinase M/B isoenzyme and troponin I results.
  • To evaluate the impact of interventions on cardiac marker study ordering practices.
  • To address clinician concerns about test discontinuation sensitivity.

Main Methods:

  • Time-sequenced interventions including computerized soft stops and peer leadership with dashboard feedback.
  • Analysis of cardiac marker studies performed within and outside of guidelines.
  • Interrupted time series analysis across multiple healthcare facilities.

Main Results:

  • Nonguideline orders were prevalent at baseline.
  • Creatine kinase M/B isoenzyme testing did not detect additional myocardial infarctions but was linked to preventable admissions.
  • Computerized interventions improved guideline compliance from 32.3% to over 80% in some services.
  • Improvements were sustained post-intervention, with significant laboratory cost savings.

Conclusions:

  • Clinicians respond to local performance data and evidence of potential harm.
  • Interventions combining electronic order entry with peer education and feedback are highly effective.
  • Pathologists can lead efforts to optimize laboratory test ordering and support value-based healthcare.