Audit-and-Feedback Utilizing Resident Consensus Standards Reduced Daily Labs.

Area of Science:

• Internal Medicine
• Clinical Laboratory Science
• Healthcare Quality Improvement

Background:

• The Choosing Wisely campaign advises against repetitive laboratory testing in stable hospitalized patients.
• Physician definitions of laboratory stability and adherence to these definitions remain unclear.

Purpose of the Study:

• To define and compare resident and hospitalist perceptions of stable complete blood count (CBC) and chemistry panels.
• To evaluate an audit-and-feedback intervention's impact on resident ordering of laboratory tests based on defined stability criteria.

Main Methods:

• A 2-round consensus survey in 2023 established resident and hospitalist definitions of stable CBC and chemistry panels.
• A 21-week audit-and-feedback intervention provided residents weekly adherence data to their cohort's stability definitions.
• The percentage of stable lab panels repeated was compared pre-intervention, during, and post-intervention.

Main Results:

• Residents considered smaller day-to-day CBC changes actionable compared to hospitalists.
• At baseline, residents repeated stable CBCs more frequently (68%) than hospitalists (54%).
• The intervention led to a sustained reduction in residents repeating stable CBCs (54% during, 59% at 6 months).

Conclusions:

• Residents' definitions of laboratory stability differed from hospitalists', leading to more frequent repetition of stable CBCs.
• Audit-and-feedback based on resident-defined stability criteria effectively reduced unnecessary CBC orders.
• This intervention demonstrates a successful strategy for improving laboratory test utilization in internal medicine residents.