A multi‐level strategy for a long lasting reduction in unnecessary laboratory testing: A multicenter before and after study in a teaching hospital network

Abstract

Summary Background Reducing unnecessary laboratory blood testing in the hospital setting represents a challenge to improve the adequacy of healthcare and a tricky task for teaching hospitals. Our hospital network actively participates in the Choosing Wisely Campaign and is engaged in avoiding unnecessary low value interventions and investigations. We aimed to study whether a multi‐level approach combining educational and web‐system based interventions, could be effective in reducing laboratory testing and related costs. Methods Multicenter, proof of concept, prospective, observational, before and after study, in a network of public hospitals in Switzerland. All patients admitted between 1 January 2015 and 31 December 2017 were analyzed. A multi‐level strategy based on online continuous monitor benchmarking and educational support was applied in the internal medicine services. The primary outcome was a significant reduction in the number of laboratory tests per patient and per day during the hospital stay. Secondary outcomes were reduction in the blood sample volume taken per patient and per day in laboratory costs. Results Over the 36 months of the study, 33 309 admissions were analyzed. A significant reduction of laboratory tests per patient and per day of hospitalisation was found:–11%, P ‐value<0.001; –6%, P ‐value <0.001. The mean monthly blood volume, per patient and per day of hospital stay and laboratory costs per patient was also significantly reduced: –7%, P ‐value<0.05; –3%, P ‐value<0.01, and –17%, P ‐value<0.01, respectively. Conclusions The obtained reduction in the number of laboratory tests, blood volume withdrawn and related costs, support the idea that an open web‐based system, involving all health care providers, coupled with educational interventions, can be helpful in generating awareness of prescriber habits and to catalyze changes in their behaviour. The peer pressure related to the unmasked benchmarking process did probably play a determinant role.

Peer‐pressure and overuse: The effect of a multimodal approach on variation in benzodiazepine prescriptions in a network of public hospitals

“…Even if numerous studies targeted to waste in healthcare have been published in recent years, interventions aiming at reducing variation in treatments and diagnostic procedures, are lacking …”

“…The original intervention, demonstrating a significant reduction in in‐hospital benzodiazepine, PPI and blood test prescriptions, started in January 2016 and was widely described elsewhere …”

“…In our hospital network, called “Ente Ospedaliero Cantonale” (EOC), composed of five teaching hospitals in the south of Switzerland, we successfully experimented an integrated, multi‐level approach aimed at curbing the in‐hospital prescription of drugs known to be over‐used [(ie benzodiazepines (BZD), and proton pump inhibitors (PPI)] and to reduce inappropriate laboratory blood testing during the hospital stay …”

Primum non nocere: Demand management in pathology and preventing harm

“…However, published audit data on the effectiveness of these guidelines is lacking. In this issue of IJCP, Erard et al describe the effects of a long‐term peer‐mentoring approach on laboratory demand management in the Swiss health system . A multi‐level strategy based on on‐line benchmarking and educational support was applied in the internal medicine over 2 years.…”

Testing, testing. 1, 2, 3. Is this mic on?

“…This issue of the International Journal of Clinical Practice includes 4 articles regarding testing in medicine. Our Associate Editor for Cardiovascular Disease Prevention and Metabolic Diseases, Anthony Wierzbicki, together with Timothy Reynolds, start us off with a thoughtful extended editorial/perspective with the title (translated) “first, do no harm.” This is followed by 3 articles that describe demand management and weekend laboratory testing requests at a general hospital in the UK, the experience of a Swiss teaching hospital network in reducing unnecessary testing, and an Australian study of the variation in investigations done for adults presenting to emergency departments with chest pain . Testing is an international problem, and although the three articles in this issue of the journal are from the “first world” it would be of interest to know more about testing in medicine is countries where resources may be more limited.…”