A Quality Improvement Initiative: Reducing Unnecessary Phlebotomy, Enhancing Patient Experience, and Minimizing Environmental Impact in the Inpatient Setting.

Abstract

Background: The steady increase in laboratory testing volume burdens the health care system with substantial costs, contributes to patient dissatisfaction, and generates adverse environmental effects. Beyond financial expenditure, unnecessary testing poses medical risks and affects patient well-being. Our quality improvement (QI) project aimed to employ a multimodal intervention to enhance appropriate laboratory utilization amongst residents and hospitalists.

Methods: This QI initiative used a multimodal intervention to enhance appropriate lab utilization among residents and hospitalists. It involved evaluating baseline knowledge gaps, implementing targeted education, and integrating daily structured discussions on lab necessity. In addition, an electronic dashboard was utilized with real-time data on lab ordering volume and labs ordered per attending.

Results: The intervention led to a net decrease of 4657 lab orders over the 3-month period. Specifically, there were significant reductions in comprehensive metabolic panel (CMP) (19.5%), serum Mg (11.8%), serum Phos (14.1%), and complete blood count (CBC) (11.2%) orders, alongside a 20% increase in basic metabolic panel (BMP) orders. Patient satisfaction improved, with affirmative "rest and recover" responses rising from 51.8% to 63.2%. This reduction generated an estimated $10,645 in cost savings and a 1304.61 kg reduction in CO2 emissions.

Conclusion: This multifaceted QI approach, integrating systemic interventions and education, effectively reduced unnecessary lab testing. It simultaneously improved patient experience, yielded cost savings, and mitigated environmental impact, offering a transferable framework.