Multifaceted Intervention Reduces In-Patient Laboratory Costs

A tool called Value Driven Outcomes has been developed to reduce superfluous laboratory testing and when integrated into a quality improvement initiative laboratory costs decreased by nearly 10% per visit.

Unnecessary laboratory testing contributes to the estimated USD 910 billion wasted each year in health care in the USA. Beyond costs, laboratory testing is an important patient safety issue. The sheer number of tests ordered can lead to incidental findings that result in unnecessary follow-up testing and potentially harmful interventions, and early morning blood draws can prevent much needed rest. Vulnerable patients can even develop anemia and associated complications from over-testing.

Scientists at the University of Utah Medical Center (Salt Lake City, UT) carried out a retrospective, controlled, interrupted time series (ITS) study to evaluate the impact of a multifaceted laboratory reduction intervention on laboratory costs. Measurements were made of the primary outcomes of laboratory cost per day and per visit. Another measurement was the 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.

The results of the interventions over a 15-month period were tangible. An intervention group of 6,310 hospitalist patient visits were compared to a control group of 25,586 non-hospitalist visits. The interventions reduced the mean cost per day for laboratory testing from USD 138 to USD 123 and the mean cost per visit decreased from USD 618 to USD 558. There was also a significant reduction in laboratory cost per day, laboratory cost per visit, and the number of tests per day.

The authors concluded that a multifaceted approach, including education, rounding checklist implementation, cost feedback, and financial incentives, 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.

Peter Yarbrough, MD, an assistant professor of internal medicine and lead author of the study, said, “Frequently, patients do need labs every morning, but that can create a culture where you're ordering tests without really thinking about what you're going to do with the results. Prior to VDO, we never had cost information. Most of the tests don't cost very much, but their numbers were so high that the total cost became significant.” The study was published on February 4, 2016, in the Journal of Hospital Medicine.

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University of Utah Medical Center