TY - JOUR
T1 - Empowering medicine residents to order labs mindfully to improve patient-centered care
AU - Rawal, Rachna
AU - Adeyemo, Oluwasayo
AU - Kunnath, Paul
AU - Vartanyan, Ara
AU - Saad, Hala
AU - Lane, Alex
AU - Schuelke, Matthew J.
AU - Sue, Yujie
AU - Drummond, Jessica
AU - Schmidt, Jennifer M.
N1 - Publisher Copyright:
© 2023 The Authors. Journal of Hospital Medicine published by Wiley Periodicals LLC on behalf of Society of Hospital Medicine.
PY - 2023/5
Y1 - 2023/5
N2 - Background: Unnecessary laboratory testing of hospitalized patients is prevalent. Objective: We conducted a study focused on “mindful ordering” to decrease unnecessary laboratory ordering within an Internal Medicine residency program. Designs, Settings and Participants: We collected survey data on resident/faculty perceptions of laboratory ordering as well as order information from the electronic medical record (EMR). Intervention: Interventions focused on resident-identified barriers such as knowledge, EMR, habit and faculty expectations. Interventions were cumulative and included resident/faculty education and EMR optimization. Main Outcomes and Measures: We assessed basic and complete metabolic panels (BMP, CMP) and complete blood counts with and without differential (CBC w/diff, w/o diff). Primary outcomes included: total labs ordered per week, lab and frequency, and resident perception of ordering practices. Secondary outcomes included: length-of stay (LOS) and venipuncture utilization. Results: Survey data demonstrated increased resident perception of both mindful ordering and team discussion. Total labs ordered per week decreased 20% in the first year (1944 to 1500 labs/week). Residents' use of the “one-time draw” option increased; use of “daily” frequency decreased. Trends showed an increase in BMP relative to CMP, and an increase in CBC w/o diff relative to CBC w/diff. These changes were sustained through 127 weeks. There was an approximately 10% decrease in monthly average of patients undergoing venipuncture each day (86.7% to 74.2%). The shifts in laboratory ordering in conjunction with increased discussion about labs suggest a sustained change in resident lab ordering behavior. This study shows the impact of focusing interventions on resident-identified barriers to mindful ordering to create a sustained decrease laboratory orders.
AB - Background: Unnecessary laboratory testing of hospitalized patients is prevalent. Objective: We conducted a study focused on “mindful ordering” to decrease unnecessary laboratory ordering within an Internal Medicine residency program. Designs, Settings and Participants: We collected survey data on resident/faculty perceptions of laboratory ordering as well as order information from the electronic medical record (EMR). Intervention: Interventions focused on resident-identified barriers such as knowledge, EMR, habit and faculty expectations. Interventions were cumulative and included resident/faculty education and EMR optimization. Main Outcomes and Measures: We assessed basic and complete metabolic panels (BMP, CMP) and complete blood counts with and without differential (CBC w/diff, w/o diff). Primary outcomes included: total labs ordered per week, lab and frequency, and resident perception of ordering practices. Secondary outcomes included: length-of stay (LOS) and venipuncture utilization. Results: Survey data demonstrated increased resident perception of both mindful ordering and team discussion. Total labs ordered per week decreased 20% in the first year (1944 to 1500 labs/week). Residents' use of the “one-time draw” option increased; use of “daily” frequency decreased. Trends showed an increase in BMP relative to CMP, and an increase in CBC w/o diff relative to CBC w/diff. These changes were sustained through 127 weeks. There was an approximately 10% decrease in monthly average of patients undergoing venipuncture each day (86.7% to 74.2%). The shifts in laboratory ordering in conjunction with increased discussion about labs suggest a sustained change in resident lab ordering behavior. This study shows the impact of focusing interventions on resident-identified barriers to mindful ordering to create a sustained decrease laboratory orders.
UR - http://www.scopus.com/inward/record.url?scp=85151419322&partnerID=8YFLogxK
U2 - 10.1002/jhm.13081
DO - 10.1002/jhm.13081
M3 - Article
C2 - 36975191
AN - SCOPUS:85151419322
SN - 1553-5592
VL - 18
SP - 398
EP - 404
JO - Journal of hospital medicine
JF - Journal of hospital medicine
IS - 5
ER -