An Educational and Administrative Intervention to Promote Rational Laboratory Test Ordering on an Academic General Medicine Service

被引:24
|
作者
Wertheim, Bradley M. [1 ,2 ,9 ]
Aguirre, Andrew J. [1 ,2 ,10 ]
Bhattacharyya, Roby P. [2 ,3 ]
Chorba, John [1 ,11 ]
Jadhav, Ashutosh P. [1 ,12 ]
Kerry, Vanessa B. [2 ,4 ]
Macklin, Eric A. [5 ]
Motyckova, Gabriela [1 ,13 ]
Raju, Shveta [1 ,6 ,14 ]
Lewandrowski, Kent [2 ,7 ]
Hunt, Daniel P. [1 ,8 ,15 ]
Wright, Douglas E. [1 ,2 ]
机构
[1] Massachusetts Gen Hosp, Dept Med, Boston, MA 02114 USA
[2] Harvard Med Sch, Boston, MA USA
[3] Massachusetts Gen Hosp, Div Infect Dis, Boston, MA 02114 USA
[4] Massachusetts Gen Hosp, Div Pulm & Crit Care Med, Boston, MA 02114 USA
[5] Massachusetts Gen Hosp, Ctr Biostat, Boston, MA 02114 USA
[6] Georgia Regents Univ, Med Coll Georgia, Augusta, GA USA
[7] Massachusetts Gen Hosp, Dept Pathol, Boston, MA 02114 USA
[8] Emory Univ, Sch Med, Atlanta, GA USA
[9] Brigham & Womens Hosp, Div Pulm & Crit Care Med, 75 Francis St, Boston, MA 02115 USA
[10] Dana Farber Canc Inst, Boston, MA 02115 USA
[11] Univ Calif San Francisco, San Francisco Gen Hosp, Dept Med, Div Cardiol, San Francisco, CA USA
[12] Univ Pittsburgh, Med Ctr, Dept Neurol & Neurol Surg, Pittsburgh, PA 15260 USA
[13] LDS Hosp, Intermt Blood & Marrow Transplant Acute Leukemia, Salt Lake City, UT USA
[14] Gwinnett Clin, Lawrenceville, GA USA
[15] Emory Univ, Div Hosp Med, Atlanta, GA 30322 USA
来源
AMERICAN JOURNAL OF MEDICINE | 2017年 / 130卷 / 01期
基金
美国国家卫生研究院;
关键词
Diagnostic tests; Medical education; Resource use; ANEMIA; PHLEBOTOMY; BEHAVIOR;
D O I
10.1016/j.amjmed.2016.08.021
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND: Overuse of clinical laboratory testing in the inpatient setting is a common problem. The objective of this project was to develop an inexpensive and easily implemented intervention to promote rational laboratory use without compromising resident education or patient care. METHODS: The study comprised of a cluster-randomized, controlled trial to assess the impact of a multifaceted intervention of education, guideline development, elimination of recurring laboratory orders, unbundling of laboratory panels, and redesign of the daily progress note on laboratory test ordering. The population included all patients hospitalized " general medicine" was duplicated during 2 consecutive months on a general medicine teaching service within a 999-bed tertiary care hospital in Boston, Massachusetts. The primary outcome was the total number of commonly used laboratory tests per patient day during 2 months in 2008. Secondary outcomes included a subgroup analysis of each individual test per patient day, adverse events, and resident and nursing satisfaction. RESULTS: A total of 5392 patient days were captured. The intervention produced a 9% decrease in aggregate laboratory use (rate ratio, 0.91; P = .021; 95% confidence interval, 0.84-0.98). Six instances of delayed diagnosis of acute kidney injury and 11 near misses were reported in the intervention arm. CONCLUSIONS: A bundled educational and administrative intervention promoting rational ordering of laboratory tests on a single academic general medicine service led to a modest but significant decrease in laboratory use. To our knowledge, this was the first study to examine the daily progress note as a tool to limit excessive test ordering. Unadjudicated near misses and possible harm were reported with this intervention. This finding warrants further study. (C) 2016 Elsevier Inc. All rights reserved.
引用
收藏
页码:47 / 53
页数:7
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