American Journal of Medicine, internal medicine, medicine, health, healthy lifestyles, cancer, heart disease, drugs

Mindfulness-Based Laboratory Reduction: Reducing Utilization Through Trainee-Led Daily ‘Time Outs’

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Overuse of laboratory investigations is widely prevalent in hospitalized patients, leads to discomfort, and increases direct and indirect costs.

Objective

We implemented a simple, inexpensive, mindfulness strategy on our inpatient medical clinical teaching unit to reduce unnecessary laboratory orders through education, a forcing function, and daily structured laboratory “time outs.”

Methods

On a 26-bed unit in an academic hospital center, the per-period laboratory costs per patient were compared pre- and postintervention using segmented regression analysis of an interrupted time series.

Results

The average cost per admitted patient decreased from $117 to $66, with an estimated savings of $50,657 over 985 admissions. After adjusting for fiscal period and the presence of our intervention, there was a significant reduction in the per-patient number of total tests, complete blood counts, and electrolyte panels performed (P<.001 for all level and time trend changes).

Conclusion

This trainee-designed and -led intervention, centered around structured, mindfulness-based laboratory test ordering, was successful at decreasing the overuse of common daily blood work in hospitalized patients.

The systematic overuse of laboratory investigations in hospitalized patients has been decried for over 2 decades.Drivers of overuse vary across and between institutions, physicians, and levels of training, and may include uncertainty of the diagnosis, lack of experience, adherence to hospital protocol or established routines, and lack of attention to, or knowledge of, associated costs.23

Indiscriminate testing reduces the quality of patient care through increased patient discomfort,4 direct and indirect costs of care (test tubes, phlebotomy, and analysis time), creating a “needle in haystack” phenomenon where important results are buried amongst the unimportant, generating false-positive results with associated diagnostic cascades, and contributing to hospital-acquired anemia.5 Routine repeated testing, particularly for common tests such as the complete blood count, is seldom helpful in clinical management.6 For these reasons, several professional societies recommend the avoidance of routine laboratories in stable patients.7

This trainee-designed and -led initiative sought to translate such recommendations into action by implementing and evaluating a simple strategy on our inpatient clinical teaching units designed to reduce unnecessary laboratory testing.

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-Emily G. McDonald, MD, MSc, Ramy R. Saleh, MD1, Todd C. Lee, MD, MPH

This article originally appeared in the June 2017 issue of The American Journal of Medicine.

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