A minimalist electronic health record-based intervention to reduce standing lab utilisation

Area of Science:

• Health Informatics
• Clinical Laboratory Science
• Healthcare Management

Background:

• Repetitive laboratory testing in stable patients represents low-value care.
• Electronic health record (EHR)-based interventions can reduce unnecessary testing but may be overly restrictive.

Purpose of the Study:

• To assess the impact of a minimally restrictive EHR-based intervention on laboratory test utilization.
• To evaluate the effectiveness of provider-initiated order limits on laboratory test frequency.

Main Methods:

• A quasi-experimental study was conducted over one year before and after the intervention at a 600-bed tertiary care hospital.
• The intervention involved requiring providers to specify the number of times each laboratory test could be ordered, rather than allowing indefinite orders.
• Data were collected for 18,000 patients across General Medicine, General Surgery, and the Intensive Care Unit (ICU).

Main Results:

• Laboratory test utilization, measured as labs performed per patient day, decreased for several tests across all services.
• Specifically, complete blood count with differential utilization dropped by 9% (p<0.001) in General Medicine and 21% (p<0.001) in the ICU.
• The number of associated laboratory orders also decreased following the intervention.

Conclusions:

• Implementing a system that requires providers to specify the number of test occurrences can significantly reduce laboratory test utilization.
• This minimally restrictive EHR-based approach offers a viable strategy to curb low-value laboratory testing.
• Further research may explore the broader applicability and long-term effects of such interventions.