• J Hosp Med · May 2016

    Review

    Multifaceted intervention including education, rounding checklist implementation, cost feedback, and financial incentives reduces inpatient laboratory costs.

    • Peter M Yarbrough, Polina V Kukhareva, Devin Horton, Karli Edholm, and Kensaku Kawamoto.
    • Department of Internal Medicine, Division of General Internal Medicine, University of Utah Medical Center, Salt Lake City, Utah.
    • J Hosp Med. 2016 May 1; 11 (5): 348-54.

    BackgroundInappropriate laboratory testing is a contributor to waste in healthcare.ObjectiveTo evaluate the impact of a multifaceted laboratory reduction intervention on laboratory costs.DesignA retrospective, controlled, interrupted time series (ITS) study.SettingUniversity of Utah Health Care, a 500-bed academic medical center in Salt Lake City, Utah.PopulationAll patients 18 years or older admitted to the hospital to a service other than obstetrics, rehabilitation, or psychiatry.InterventionMultifaceted quality-improvement initiative in a hospitalist service including education, process change, cost feedback, and financial incentive.MeasurementsPrimary outcomes of lab cost per day and per visit. Secondary outcomes of number of basic metabolic panel (BMP), comprehensive metabolic panel (CMP), complete blood count (CBC), and prothrombin time/international normalized ratio tests per day; length of stay (LOS); and 30-day readmissions.ResultsA total of 6310 hospitalist patient visits (intervention group) were compared to 25,586 nonhospitalist visits (control group). Among the intervention group, the unadjusted mean cost per day was reduced from $138 before the intervention to $123 after the intervention (P < 0.001), and the unadjusted mean cost per visit decreased from $618 to $558 (P = 0.005). The ITS analysis showed significant reductions in cost per day, cost per visit, and the number of BMP, CMP, and CBC tests per day (P = 0.034, 0.02, <0.001, 0.004, and <0.001). LOS was unchanged and 30-day readmissions decreased in the intervention group.ConclusionA multifaceted approach to laboratory reduction demonstrated a significant reduction in laboratory cost per day and per visit, as well as common tests per day at a major academic medical center. Journal of Hospital Medicine 2016;11:348-354. © 2016 Society of Hospital Medicine.© 2016 Society of Hospital Medicine.

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