Integrating High-Value Care and Environmental Sustainability to Reduce Unnecessary Laboratory Testing by Residents:...

Area of Science:

• Medical Education
• Healthcare Sustainability
• Clinical Practice Improvement

Background:

• Routine laboratory testing in stable inpatients constitutes low-value care and significantly contributes to healthcare's carbon footprint.
• The US healthcare system's greenhouse gas emissions rank it among the top global emitters.
• Integrating high-value care principles with environmental sustainability offers a novel strategy to decrease unnecessary lab tests and reduce carbon emissions.

Purpose of the Study:

• To evaluate the impact of an intervention that merges environmental sustainability and high-value care concepts on resident physicians' laboratory ordering practices.
• To assess the effectiveness of this integrated approach in modifying physician behavior regarding lab test utilization.

Main Methods:

• A 6-month pilot study employing a concurrent control versus intervention design.
• Two internal medicine teams at an urban academic tertiary care center participated, with matched composition of attending and resident physicians.
• The intervention included educational videos on the environmental impact of testing, daily team-based lab order reviews, and reminder emails, alongside quantitative surveys for residents.

Main Results:

• The intervention group showed a statistically significant reduction in average labs per patient per day (3.62 vs. 3.91) and venipunctures per patient per day (1.32 vs. 1.39) compared to the control group.
• An estimated 81 kg of carbon dioxide (CO2) emissions were saved.
• The proportion of residents assessing clinical lab indications multiple times weekly or daily increased significantly from 47.8% pre-intervention to 86.9% post-intervention.

Conclusions:

• An intervention integrating high-value care and environmental sustainability effectively altered resident physicians' laboratory ordering behaviors.
• This approach led to a decrease in both the number of lab tests and venipunctures, consequently reducing the carbon footprint.
• This strategy presents a valuable method for mitigating unnecessary laboratory testing and low-value care within the healthcare system.