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Reducing Daily Laboratory Tests in a Rural-Serving Health System: Insights and Challenges
Introduction:
Laboratory test utilization initiatives are well-studied in academic centers but less so in rural and community hospitals. We applied the EPIDEM model ( e xploration, p romotion, i mplementation, d ocumentation, e valuation, m odification) across a nine-hospital, predominantly rural health system to reduce unnecessary daily laboratory tests.
Methods:
At the medical center, we began engaging key partners in October 2020 through targeted in-person meetings. Electronic health record (EHR) interventions (removing daily ×3 ordering, Choosing Wisely reminders, interval-based ordering restrictions) started system-wide in April 2021. Regional hospitals received EHR interventions and educational materials only.
Results:
After clinical leadership approval in December 2020, our initiative's popularity accelerated, as groups requested inclusion. Across the health system, there was a 6%-20% reduction in tests per inpatient day. At the medical center, ordering decreased in December 2020 and dropped further with each EHR intervention. Unlike the sustained improvement observed at the medical center, ordering initially increased in the regional hospitals, decreased with each EHR intervention, but ultimately returned near baseline levels.
Conclusions:
Social and behavioral strategies are essential for sustaining daily laboratory test reduction efforts. Lasting cultural change may require local champions at each hospital. The EPIDEM model prioritizes relational and contextual factors, enabling quality improvement even in resource-limited settings.
