Quality Improvement Intervention for Reduction of Redundant Testing

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.