• Dawi Shin, Hyung J Cho, Surafel Tsega, Daniel Alaiev, Joseph Talledo, Komal Chandra, ManchegoPeter AlarconPADepartment of Quality and Safety, NYC Health + Hospitals, New York, NY, USA.Department of Pediatrics, NYC Health + Hospitals/Kings County, New York, NY, USA., Milana Zaurova, Mariely Garcia, Jessica Jacobson, and Mona Krouss.
• Icahn School of Medicine, New York, NY, USA.
• J Gen Intern Med. 2024 Jan 1; 39 (1): 131813-18.

BackgroundAccording to the American Association of Blood Banks, a Type and Screen (T&S) is valid for up to three calendar days. Beyond a limited number of clinical indications such as a transfusion reaction, repeat T&S testing within 3 days is not warranted. Inappropriate repeat T&S testing is a costly medical waste and can lead to patient harm.ObjectiveTo reduce inappropriate duplicate T&S testing across a large, multihospital setting.SettingThe largest urban safety net health system in the USA, with 11 acute care hospitals.InterventionsOur first intervention involved adding the time elapsed since the last T&S order into the order and the process instructions that described when a T&S was indicated. The second intervention was a best practice advisory that triggered when T&S was ordered before the expiration of an active T&S.Main MeasuresThe primary outcome measure was the number of duplicate inpatient T&S per 1000 patient days.Key ResultsAcross all hospitals, the weekly average rate of duplicate T&S ordering decreased from 8.42 to 7.37 per 1000 patient days (12.5% reduction, p < 0.001) after the first intervention and to 4.32 per 1000 patient days (48.7% reduction, p < 0.001) after the second intervention. Using linear regression to compare pre-intervention to post-intervention 1, the level difference was - 2.46 (9.17 to 6.70, p < 0.001) and slope difference was 0.0001 (0.0282 to 0.0283, p = 1). For post-intervention 1 to post-intervention 2, the level difference was - 3.49 (8.06 to 4.58, p < 0.001) and slope difference was - 0.0428 (0.0283 to - 0.0145, p < 0.05).ConclusionsOur intervention successfully reduced duplicate T&S testing using a two-pronged electronic health record intervention. The success of this low effort intervention across a diverse health system provides a framework for similar interventions in various clinical settings.© 2023. The Author(s), under exclusive licence to Society of General Internal Medicine.

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