Reducing Overuse of 3-Day Repeat Type and Screen Testing across an 11-Hospital Safety Net System.

Area of Science:

• Healthcare Management
• Clinical Laboratory Science
• Health Informatics

Background:

• Type and Screen (T&S) validity is limited to three days per AABB guidelines.
• Repeat T&S testing within three days is generally unwarranted and considered medical waste.
• Inappropriate T&S testing poses financial burdens and potential patient harm.

Purpose of the Study:

• To decrease inappropriate duplicate Type and Screen (T&S) testing across multiple hospitals.
• To implement and evaluate electronic health record (EHR) based interventions.

Main Methods:

• A multi-hospital setting comprising 11 acute care facilities within a large urban safety net health system.
• Interventions included enhancing order entry with elapsed time since last T&S and implementing a best practice advisory for duplicate orders.
• The primary outcome measured was the rate of duplicate inpatient T&S per 1000 patient days.

Main Results:

• The first intervention reduced duplicate T&S rates by 12.5% (p < 0.001).
• The second intervention further decreased rates by 48.7% (p < 0.001) from baseline.
• Statistical analysis confirmed significant reductions in both level and slope differences post-interventions.

Conclusions:

• A two-pronged EHR intervention effectively reduced duplicate T&S testing.
• This low-effort strategy offers a scalable framework for other clinical settings.
• The findings highlight the potential of health informatics to optimize laboratory utilization and patient care.