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Original research
A minimalist electronic health record-based intervention to reduce standing lab utilisation
  1. Kuo-Kai Chin1,
  2. Amrita Krishnamurthy2,
  3. Talhah Zubair1,
  4. Tara Ramaswamy2,
  5. Jason Hom2,
  6. Paul Maggio3,
  7. Lisa Shieh2
  1. 1 Stanford University School of Medicine, Stanford, California, USA
  2. 2 Department of Medicine, Stanford University, Stanford, California, USA
  3. 3 Department of Surgery, Stanford University, Stanford, California, USA
  1. Correspondence to Dr Lisa Shieh, Department of Medicine, Stanford University, Stanford, CA 94305, USA; lshieh{at}stanford.edu

Abstract

Background Repetitive laboratory testing in stable patients is low-value care. Electronic health record (EHR)-based interventions are easy to disseminate but can be restrictive.

Objective To evaluate the effect of a minimally restrictive EHR-based intervention on utilisation.

Setting One year before and after intervention at a 600-bed tertiary care hospital. 18 000 patients admitted to General Medicine, General Surgery and the Intensive Care Unit (ICU).

Intervention Providers were required to specify the number of times each test should occur instead of being able to order them indefinitely.

Measurements For eight tests, utilisation (number of labs performed per patient day) and number of associated orders were measured.

Results Utilisation decreased for some tests on all services. Notably, complete blood count with differential decreased 9% (p<0.001) on General Medicine and 21% (p<0.001) in the ICU.

Conclusions Requiring providers to specify the number of occurrences of labs changes significantly reduces utilisation in some cases.

  • quality in health care
  • internal medicine
  • adult intensive & critical care
  • health informatics

http://dx.doi.org/10.1136/postgradmedj-2019-136992

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    Footnotes

    • Contributors LS had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: PM, JH, LS. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: K-KC, AK. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: K-KC. Study supervision: LS.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request. All data are available upon reasonable request.