[{"innerBlocks":[],"name":"core\/freeform","postId":2857,"blockType":{"name":"core\/freeform","keywords":[],"attributes":{"content":{"type":"string","source":"raw"},"lock":{"type":"object"}},"providesContext":[],"usesContext":[],"selectors":[],"supports":{"className":false,"customClassName":false,"reusable":false},"styles":[],"variations":[],"apiVersion":3,"title":"Classic","description":"Use the classic WordPress editor.","category":"text"},"originalContent":"Researchers have developed evidence-based guidelines intended to help hospitals eliminate unnecessary medical testing, and are developing an approach to deliver the guidelines to clinicians through electronic health records.

In addition to limiting unnecessary tests, the initiative intends to give providers real-time feedback on their ordering patterns with anonymized comparative data.

The guidelines, published<\/a> this week in JAMA Internal Medicine<\/i>, were developed by researchers at Johns Hopkins University, the University of Michigan, University of Pennsylvania, University of Toronto and the University of Virginia\u2014all members of the High Value Practice Academic Alliance, a coalition of more than 80 academic medical centers working to improve healthcare by eliminating waste.

\u201cAlthough laboratory expenditure often represents less than 5 percent of most hospital budgets, the impact is far-reaching given that laboratory tests influence nearly 60 percent to 70 percent of all medical decisions,\u201d state the authors. \u201cExcessive phlebotomy can lead to hospital-acquired anemia, increased costs, and unnecessary downstream testing and procedures.\u201d

Laboratory testing of hospitalized patients is one of the largest contributors to wasteful healthcare spending, according to Andrew Parsons, MD, a co-author of the article, a hospitalist in the University of Virginia Health System and assistant professor at the University of Virginia School of Medicine.

\u201cA number of hospitals have taken on their own initiatives to try and reduce unnecessary laboratory testing, but there really hasn\u2019t been\u2014until now\u2014a united effort,\u201d says Parsons. \u201cWhat we wanted to do was review different interventions that have been instituted, see what was most effective, and then put together an implementation blueprint to guide hospital teams so they can improve their practices.\u201d

Also See<\/b>: Cedars-Sinai reduces unnecessary care using EHR alerts<\/a>

Parsons notes that the evidence-based guidelines developed by him and his colleagues are based on real-world implementations with recommendations in three areas of practice relating to medical tests: educational initiatives, leveraging EHRs, and real-time clinician feedback on test ordering patterns.

\u201cMost of the successful studies didn\u2019t just do one of those things, they took a multi-level approach doing all three,\u201d he contends. \u201cIt\u2019s not standard practice to consider the cost of the test. But hospitals should educate providers on the cost of the tests they order. We also want to educate them on the negative effects of unnecessary laboratory testing, such as developing anemia in the hospital and downstream testing that comes from false positive results of the laboratory tests that they order.\u201d

When it comes to using EHRs, Parsons urges hospitals to customize their systems to set up alerts to notify clinicians as they attempt to order tests electronically. \u201cAs soon as a provider goes to put into an order, an alert pops up that says \u2018FYI, this was just ordered yesterday or this test has been done within a given period of time and here\u2019s the result\u2014do you still want to order this test?'\u201d he observes.

In addition, Parsons recommends that hospitals limit the ability of physicians to order laboratory tests. \u201cIt\u2019s a common practice to pre-order laboratory tests\u2014when a patient comes in the hospital\u2014out three to four days,\u201d he says. \u201cWe\u2019d like to restrict that and really force the provider to think each day about only the test they want to order for the following day.\u201d

Parsons also advises that hospitals give providers real-time feedback on their ordering patterns for tests, so they can adjust those practices accordingly. This feedback should also include anonymized comparative data to show how they stack up to their peers in terms of ordering behavior.

\u201cKeeping things anonymous, they should on a weekly basis send out a staff directive with average ordering patterns per patient per day,\u201d he adds. \u201cYou access the EHR to pull out all that information on orders. This has been highly effective.\u201d

Parsons laments the fact tests are often ordered in a knee-jerk fashion. However, he and his fellow researchers encourage clinicians to reconsider the use of routine daily lab tests performed on hospitalized patients, such as a complete blood count used to evaluate overall health and detect a wide range of disorders as well as a basic metabolic panel which measures glucose level, electrolyte and fluid balance, and kidney function.

\u201cEfforts to reduce the frequency of laboratory orders can improve patient satisfaction and reduce cost without negatively affecting patient outcomes,\u201d concludes the JAMA<\/i> article. \u201cHealthcare professionals and administrative leaders should carefully strategize and optimize efforts to reduce daily laboratory testing.\u201d","saveContent":"Researchers have developed evidence-based guidelines intended to help hospitals eliminate unnecessary medical testing, and are developing an approach to deliver the guidelines to clinicians through electronic health records.

In addition to limiting unnecessary tests, the initiative intends to give providers real-time feedback on their ordering patterns with anonymized comparative data.

The guidelines, published<\/a> this week in JAMA Internal Medicine<\/i>, were developed by researchers at Johns Hopkins University, the University of Michigan, University of Pennsylvania, University of Toronto and the University of Virginia\u2014all members of the High Value Practice Academic Alliance, a coalition of more than 80 academic medical centers working to improve healthcare by eliminating waste.

\u201cAlthough laboratory expenditure often represents less than 5 percent of most hospital budgets, the impact is far-reaching given that laboratory tests influence nearly 60 percent to 70 percent of all medical decisions,\u201d state the authors. \u201cExcessive phlebotomy can lead to hospital-acquired anemia, increased costs, and unnecessary downstream testing and procedures.\u201d

Laboratory testing of hospitalized patients is one of the largest contributors to wasteful healthcare spending, according to Andrew Parsons, MD, a co-author of the article, a hospitalist in the University of Virginia Health System and assistant professor at the University of Virginia School of Medicine.

\u201cA number of hospitals have taken on their own initiatives to try and reduce unnecessary laboratory testing, but there really hasn\u2019t been\u2014until now\u2014a united effort,\u201d says Parsons. \u201cWhat we wanted to do was review different interventions that have been instituted, see what was most effective, and then put together an implementation blueprint to guide hospital teams so they can improve their practices.\u201d

Also See<\/b>: Cedars-Sinai reduces unnecessary care using EHR alerts<\/a>

Parsons notes that the evidence-based guidelines developed by him and his colleagues are based on real-world implementations with recommendations in three areas of practice relating to medical tests: educational initiatives, leveraging EHRs, and real-time clinician feedback on test ordering patterns.

\u201cMost of the successful studies didn\u2019t just do one of those things, they took a multi-level approach doing all three,\u201d he contends. \u201cIt\u2019s not standard practice to consider the cost of the test. But hospitals should educate providers on the cost of the tests they order. We also want to educate them on the negative effects of unnecessary laboratory testing, such as developing anemia in the hospital and downstream testing that comes from false positive results of the laboratory tests that they order.\u201d

When it comes to using EHRs, Parsons urges hospitals to customize their systems to set up alerts to notify clinicians as they attempt to order tests electronically. \u201cAs soon as a provider goes to put into an order, an alert pops up that says \u2018FYI, this was just ordered yesterday or this test has been done within a given period of time and here\u2019s the result\u2014do you still want to order this test?'\u201d he observes.

In addition, Parsons recommends that hospitals limit the ability of physicians to order laboratory tests. \u201cIt\u2019s a common practice to pre-order laboratory tests\u2014when a patient comes in the hospital\u2014out three to four days,\u201d he says. \u201cWe\u2019d like to restrict that and really force the provider to think each day about only the test they want to order for the following day.\u201d

Parsons also advises that hospitals give providers real-time feedback on their ordering patterns for tests, so they can adjust those practices accordingly. This feedback should also include anonymized comparative data to show how they stack up to their peers in terms of ordering behavior.

\u201cKeeping things anonymous, they should on a weekly basis send out a staff directive with average ordering patterns per patient per day,\u201d he adds. \u201cYou access the EHR to pull out all that information on orders. This has been highly effective.\u201d

Parsons laments the fact tests are often ordered in a knee-jerk fashion. However, he and his fellow researchers encourage clinicians to reconsider the use of routine daily lab tests performed on hospitalized patients, such as a complete blood count used to evaluate overall health and detect a wide range of disorders as well as a basic metabolic panel which measures glucose level, electrolyte and fluid balance, and kidney function.

\u201cEfforts to reduce the frequency of laboratory orders can improve patient satisfaction and reduce cost without negatively affecting patient outcomes,\u201d concludes the JAMA<\/i> article. \u201cHealthcare professionals and administrative leaders should carefully strategize and optimize efforts to reduce daily laboratory testing.\u201d","order":0,"get_parent":{},"attributes":[],"attributesType":{"content":{"type":"string","source":"raw"},"lock":{"type":"object"}},"dynamicContent":""}]

Hospitals provide guidelines for eliminating unnecessary medical tests

More for you