A minimalist electronic health record-based intervention to reduce standing lab utilisation

Postgrad Med J. 2021 Feb;97(1144):97-102. doi: 10.1136/postgradmedj-2019-136992. Epub 2020 Feb 12.

Abstract

Background: Repetitive laboratory testing in stable patients is low-value care. Electronic health record (EHR)-based interventions are easy to disseminate but can be restrictive.

Objective: To evaluate the effect of a minimally restrictive EHR-based intervention on utilisation.

Setting: One year before and after intervention at a 600-bed tertiary care hospital. 18 000 patients admitted to General Medicine, General Surgery and the Intensive Care Unit (ICU).

Intervention: Providers were required to specify the number of times each test should occur instead of being able to order them indefinitely.

Measurements: For eight tests, utilisation (number of labs performed per patient day) and number of associated orders were measured.

Results: Utilisation decreased for some tests on all services. Notably, complete blood count with differential decreased 9% (p<0.001) on General Medicine and 21% (p<0.001) in the ICU.

Conclusions: Requiring providers to specify the number of occurrences of labs changes significantly reduces utilisation in some cases.

Keywords: adult intensive & critical care; health informatics; internal medicine; quality in health care.

MeSH terms

  • Diagnostic Tests, Routine / statistics & numerical data*
  • Electronic Health Records*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Retreatment / statistics & numerical data
  • Retrospective Studies
  • Unnecessary Procedures / statistics & numerical data*
  • Utilization Review*