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Evaluation of a Multilevel Laboratory Stewardship Intervention Targeted to Cardiac and Thoracic Surgical Services at
Patrick C Mathias1, Sara Khor2, Kathryn Harris3
1From the Departments of Laboratory Medicine and Pathology and Biomedical Informatics and Medical Education (Mathias), University of Washington, Seattle.
Insights
A laboratory stewardship intervention significantly reduced unnecessary lab tests in surgical services. This initiative decreased lab tests per patient-day without adverse effects on patient outcomes like length of stay or readmissions.
Area of Science:
- Healthcare Management
- Clinical Pathology
- Surgical Services
Background:
- Unnecessary laboratory testing is driven by factors including preselected order sets, clinician habits, and trainee concerns.
- Excessive laboratory utilization leads to increased patient discomfort, iatrogenic anemia, bloodstream infection risk, and elevated healthcare costs.
Purpose of the Study:
- To implement and evaluate a multilevel laboratory stewardship intervention aimed at reducing unnecessary laboratory testing.
- To measure the impact of the intervention on laboratory tests per patient-day in two surgical divisions.
Main Methods:
- A multilevel intervention comprising stakeholder engagement, provider education, computerized provider order entry modification, performance feedback, and leadership-supported culture change was implemented.
- The primary outcome was laboratory tests ordered per patient-day, with secondary outcomes including blood draws, costs, length of stay, discharge disposition, readmissions, and mortality.
- A difference-in-differences analysis compared intervention services with control surgical services.
Main Results:
- The intervention led to a significant decrease in laboratory tests per patient-day in both thoracic and cardiac surgery services, with an estimated 20,000 fewer tests performed.
- A reduction of 1.5 to 2 fewer tests per patient-day was observed.
- Blood draws per patient-day significantly decreased in the thoracic surgery service but not in the cardiac surgery service.
Conclusions:
- A multilevel laboratory stewardship intervention effectively reduced laboratory test utilization in two surgical services.
- The intervention demonstrated a significant decrease in laboratory tests without negatively impacting key patient outcomes such as length of stay, readmissions, or mortality.
Context.—:
Unnecessary laboratory tests are ordered because of factors such as preselected orders on order sets, clinician habits, and trainee concerns. Excessive use of laboratory testing increases patient discomfort via unnecessary phlebotomy, contributes to iatrogenic anemia, increases risk of bloodstream infections, and increases the cost of care.
Objective.—:
To address these concerns, we implemented a multilevel laboratory stewardship intervention to decrease unnecessary laboratory testing, measured by laboratory tests per day attributed to service, across 2 surgical divisions with high laboratory use.
Design.—:
The multilevel intervention included 5 components: stakeholder engagement, provider education, computerized provider order entry modification, performance feedback, and culture change supported by leadership. The primary outcome of the study was laboratory tests ordered per patient-day. Secondary outcomes included the number of blood draws per patient-day, total lab-associated costs, length of stay, discharge to a nursing facility, 30-day readmissions, and deaths. A difference-in-differences analytic approach assessed the outcome measures in the intervention period, with other surgical services as controls.
Results.—:
The primary outcome of laboratory tests per patient-day showed a significant decrease across both thoracic and cardiac surgery services, with between 1.5 and 2 fewer tests ordered per patient-day for both services and an estimated 20 000 fewer tests performed during the intervention period. Blood draws per patient-day were also significantly decreased on the thoracic surgery service but not for cardiac surgery.
Conclusions.—:
A multilevel laboratory stewardship intervention targeted to 2 surgical services resulted in a significant decrease in laboratory test use without negatively impacting length of stay, readmissions, or mortality.
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