Utilization, Health Care
Conditions
Keywords
Overutilization of lab test, Multimodal intervention, Lab test overuse, Laboratory, Hospital
Brief summary
Laboratory test overuse occurs when tests are ordered repetitively, without due consideration of impact on clinical status. Repetitive inpatient lab testing often provides limited value for patient outcomes while increasing healthcare costs, patient discomfort, and unnecessary transfusions and prolonging hospitalizations. The research study aims to reduce laboratory test overuse in hospitals through implementation of a comprehensive, multi-disciplinary, and multi-faceted intervention bundle that includes audit and feedback reports, clinician education, clinical decision support tool, and patient infographics across 14 hospitals in Alberta.
Detailed description
Background: Laboratory and Pathology testing contributes to rising health care expenditure. A relatively large percentage (up to 42%) of laboratory testing can be considered wasteful. Redundant testing alone has been estimated to waste up to 5 billion dollars annually in the United States of America. Laboratory over-utilization leads to false positives that promotes further inappropriate testing and procedures, interruption of normal sleep pattern of inpatients, as well as iatrogenic anemia and pain. A Canadian study showed significant hemoglobin reductions as a result of phlebotomy. Studies support the safe reduction of repetitive laboratory testing without negative effects on adverse events, readmission rates, critical care utilization, or mortality. The aim of this research study is the following: 1. To implement a multimodal intervention bundle containing healthcare provider and patient engagement tools for hospitalized medical inpatients in 14 hospitals across the province of Alberta in Canada using a cluster randomized stepped-wedge design 2. To evaluate the impact of the intervention bundle on laboratory test utilization of six target laboratory tests (complete blood count, electrolytes, creatinine, urea, partial thromboplastin time, and international normalized ratio), costs, and patient safety outcomes. This intervention bundle will be implemented across all the adult hospital sites in Alberta starting January 2023 and evaluated until October 2024.
Interventions
OTHERMultimodal Intervention: Education
The multimodal intervention bundle consists of education, audit and feedback, patient engagement, and system changes.
OTHERMultimodal Intervention: Audit and Feedback
The multimodal intervention bundle consists of education, audit and feedback, patient engagement, and system changes.
OTHERMultimodal Intervention: Patient Engagement
The multimodal intervention bundle consists of education, audit and feedback, patient engagement, and system changes.
OTHERMultimodal Intervention: System Changes
The multimodal intervention bundle consists of education, audit and feedback, patient engagement, and system changes.
Sponsors
University of Calgary
Alberta Health services
University of British Columbia
Canadian Institutes of Health Research (CIHR)
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Intervention model description
Stepped-wedge cluster randomized trial, randomizing the sequence of entry into intervention at a cluster level.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* all participants (patients and healthcare providers) within enrolled adult hospitals in Alberta of medical and hospitalist units during study period
Exclusion criteria
* outside of the above-mentioned province * hospitals not enrolled * non-medical units (eg. ICU, surgical, pediatric, obstetrical units)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of routine laboratory tests ordered per patient-day in the intervention versus control periods | 1 year 9 months | Number of the six target laboratory tests (complete blood count, electrolytes, creatinine, urea, international normalized ratio and partial thromboplastin time) ordered per patient-day |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Costs associated with routine and all common laboratory test ordered | 1 year 9 months | Costs of test and associated costs with and without intervention |
| Proportion of hospital patient lab-free days | 1 year 9 months | Number of hospital patient-days not associated with laboratory blood draws |
| Proportion of critically abnormal test results | 1 year 9 months | As defined by lab standards, we will track the proportion of critically abnormal test results |
| Length of stay | 1 year 9 months | Patient length of stay on the unit |
| Transfer to Intensive Care Unit | 1 year 9 months | Transfer rate to Intensive Care Unit |
| In-patient and 30-day patient mortality over study period | 30 days post discharge | Mortality rate in hospital and at 30-days post discharge |
| 30-day post discharge readmission rate | 30 days post discharge | Hospital re-admission within 30 days post discharge |
| Number of all common laboratory tests | 1 year 9 months | Number of all common laboratory tests (tests that contribute to \>80% of hospital laboratory test utilization during study period) per patient-day. |
Countries
Canada
Contacts
PRINCIPAL_INVESTIGATORAnshula Ambasta
University of Calgary
Outcome results
None listed