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Student and Resident Research RESIDENT QUALITY IMPROVEMENT WINNER Reducing Unnecessary Routine Lab Tests for Hospitalized Medical Patients BY JOEL BEACHEY, MD, URSHILA DURANI, ELSIE T. MENSAH, MD, PRIYA VIJAYVARGIYA, JOHN T. RATELLE, MD, AND SARA REPPERT, MD, MAYO CLINIC outine ordering of basic blood tests contributing to the problem. A root-cause CBCs and 125 electrolyte panels were or- in the hospital drives up health care analysis was performed outlining those dered on 32 patients in the three days pre- Rcosts, increases risk of iatrogenic factors and barriers to change. Factors ceding the intervention. Forty-five CBCs anemia and nosocomial infections, and contributing to the ordering of unneces- and 68 electrolyte panels were ordered on extends length of stay. Reducing unneces- sary lab tests included resident inexperi- 34 patients in the three days post-inter- sary labs may ultimately improve patient ence, unclear expectations set by supervis- vention. The average number of labs per safety and outcomes, increase satisfaction ing physicians and ease of ordering daily patient-day for the three days prior to the and lessen financial burden. morning labs. Based on the root-cause intervention was 2.7. The average number analysis, provider education was selected of labs per patient-day for the three days Objective as the intervention strategy. For the initial after the intervention was 1.8. We aimed to reduce the number of rou- Plan-Do-Study-Act (PDSA), residents tine complete blood counts (CBCs) and were asked to list “Daily Labs” as a num- Conclusion electrolyte panels ordered on the medi- bered problem in their progress notes Encouraging providers to routinely con- cine teaching services at Mayo Clinic’s St. and indicate whether daily CBCs and/ sider and document the necessity of daily Marys Hospital. or electrolyte panels were necessary for labs led to a 33% reduction in tests ordered each patient. Total numbers of CBCs and per patient-day. Although the duration Methods electrolyte panels were measured for three of this initial PDSA cycle was limited, This quality improvement project involved days before and after the intervention, and results indicate that provider training and two general medicine teaching services on data were compiled in a run-chart. The accountability can potentially decrease un- the St. Marys Hospital campus in Roch- outcome measured was the average num- necessary routine lab tests. Future PDSA ester. Stakeholders were identified and ber of routine labs per patient per day. cycles can be designed to assess sustain- included patients, providers, nurses, lab ability and applicability of this interven- technicians and hospital administrators. Results tion in addition to assessing the impact on Interviews were conducted with members Fifty-four patients were admitted to the patient outcomes and cost of care. MM of each group in order to determine factors medicine 1 and 3 teaching services during our six-day analysis period. Seventy-one 48 | MINNESOTA MEDICINE | MARCH 2015.

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