A Multidisciplinary Housestaff-Led Initiative to Safely Reduce Daily Laboratory Testing
| Autor: | Cecelia Theobald, Kathryn Goggins, Sunil Kripalani, Meghan E. Kapp, Donald W. Brady, Wade T. Iams, Eszter Szentirmai, Patricia Kleinholz, David L Leverenz, Josh M. Heck, Irene Valerio-Navarrete, Michael A. Vella, Kevin Flemmons, Kelly C. Sponsler, Cody H. Penrod |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
Faculty Medical Steering committee education Unnecessary Procedures 01 natural sciences Laboratory testing Faculty medical Education 03 medical and health sciences 0302 clinical medicine Multidisciplinary approach Unnecessary Procedure Milestone (project management) Humans Medicine University medical Interdisciplinary communication 030212 general & internal medicine 0101 mathematics Quality Indicators Health Care Retrospective Studies Clinical Laboratory Techniques business.industry 010102 general mathematics Internship and Residency General Medicine medicine.disease Tennessee Leadership Hospitalists Family medicine Linear Models Education Medical Continuing Interdisciplinary Communication Medical emergency business |
| Zdroj: | Academic Medicine. 91:813-820 |
| ISSN: | 1040-2446 |
| Popis: | Provision of high-value care is a milestone in physician training. The authors evaluated the effect of a housestaff-led initiative on laboratory testing rates.Vanderbilt University Medical Center's Choosing Wisely steering committee, led by housestaff with faculty advisors, sought to reduce unnecessary daily basic metabolic panel (BMP) and complete blood count (CBC) testing on inpatient general medicine and surgical services. Intervention services received a didactic session followed by regular data feedback with goal rates and peer comparison. Testing rates during January 1, 2013-February 9, 2015, were compared on intervention services and control services using a difference-in-differences analysis and an interrupted time-series analysis with segmented linear regression.Compared with concurrent controls, the mean number of BMP tests per patient day decreased by an additional 0.23 (95% CI 0.17-0.29) on medical housestaff and 0.15 (95% CI 0.09-0.21) on hospitalist intervention services. Daily CBC tests decreased by an additional 0.28 (95% CI 0.23-0.33) on medical housestaff, 0.08 (95% CI 0.03-0.13) on hospitalist, and 0.12 (95% CI 0.05-0.20) on surgical housestaff intervention services. Patients with lab-free days (0 labs ordered in 24 hours) increased by an additional 4.1 percentage points (95% CI 2.1-6.1) on medical housestaff and 9.7 percentage points (95% CI 6.6-12.8) on hospitalist intervention services. There were no adverse changes in length of stay or intensive care unit transfer, in-hospital mortality, or 30-day readmission rates.A housestaff-led intervention utilizing education and data feedback with goal setting and peer comparison resulted in safe, significant reductions in daily laboratory testing rates. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|