Reducing Unnecessary Labs in a Teaching Hospital

Theoretical Background and research questions/hypothesis:

In this age of desiring better health care with lower costs, reducing unnecessary laboratory testing can be beneficial to help accomplish both. Not only is cost an issue but ordering repetitive labs have consequences of further invasive testing that can lead to increased health risks and medical errors for patients. Physicians repeat labs in stable patients because fear of future abnormal labs, laboratory evidence to back clinical suspicion, defensive medicine, monitor the disease process, and clarify thought process to make medical decisions. At our facility the cash pay prices for the following lab tests are: BMP $169, CBC $150, BNP $299, Lipase $94, Amylase $115, CRP $68, and ESR $54.

Our goal was to reduce unnecessary laboratory test ordering by attending and resident physicians at the Baylor Scott & White Medical Center in Round Rock, TX by increasing awareness of excessive lab ordering during the months of April and May 2018 with reduction of total lab frequency and lab frequency per patient by 10%. For the BMP, CBC, and BNP, the main goal was to reduce repeat ordering. The ACP Choosing Wisely guidelines show that routinely ordering labs daily is not helpful, unless you need them to change management. For amylase/lipase and ESR/CRP, the ACP Choosing Wisely guidelines recommend ordering a lipase instead of amylase and CRP instead of ESR. Lipase and CRP are more sensitive markers for pancreatitis and inflammation, respectively.

Methods:

Our plan for these goals was to increase awareness to attending and resident physicians about being conscious and reducing repetitive daily labs. We placed posters throughout the hospital and discussed this plan with physicians at their monthly meeting.

Results:

There was a decrease of approximately 19% in BMP, decrease of 4% in CBC, decrease of 6% in BNP, decrease of 57% in amylase, and increase of 33% in ESR. The benefits of reducing unnecessary inpatient labs are improved patient outcome and satisfaction due to fewer needle sticks and decreased phlebotomy, reduction in medical errors due to abnormal labs, and reduction in costs for patients and the hospital. The potential cost savings from this project within two months was $88,879 from a mere $5 for printing and laminating costs for the posters.

Conclusions:

Overall, lab ordering frequency was reduced by 20%. In summary, the key learnings are lab testing is expensive, costs can be reduced by ordering daily labs only if necessary, patient safety and satisfaction can be increased, and medical errors can be reduced.

Implications for research and/or practice:

There will be continued education to more health care providers. We plan to incorporate and hopefully reduce other labs (ex: magnesium, troponin, procalcitonin, etc) that are potentially being ordered excessively. We can also spread this project to other Baylor Scott & White hospitals.