Background: Patients admitted to the cardiothoracic intensive care unit (CTICU) require frequent laboratory evaluation. However, lab tests are also known to contribute to healthcare waste. It is estimated that 30-50% of tests for hospitalized patients are unnecessary. Redundant lab tests are estimated to waste up to $5 billion per year in the United States. Causes of redundant testing include, but are not limited to, orders that recur automatically without reassessing clinical necessity, short time intervals between labs with low likelihood for clinically relevant change, and repeat draws of lab panels to evaluate a single disturbance.
Objective: Quality improvement initiative carried out in the CTICU at Children's Hospital Los Angeles from January 2021 to October 2021 to reduce laboratory testing charges per patient days.
Methods: A planning meeting was held in January 2021 with CTICU nurse practitioners, nursing leadership, and physicians. In August 2021 meetings with nursing staff were held, weekly staff-wide educational emails were sent, and the costs of common lab tests were posted in high-traffic areas. Finally, six weeks of educational games and auditing of rounds were carried out from August to October 2021. Staff members guessed the prices of various laboratory tests or the amount spent for individual patients. Data for total lab charges and lab draws per patient days were obtained for August-October 2019-2021 via retrospective chart review and analyzed on excel.
Results: Average patient days from 2019, 2020, and 2021 were 660, 615, and 743 days, respectively. Total laboratory charges per patient days decreased from $2469 in August 2021 to $1791 in September 2021 and $1819 in October 2021. The total laboratory charges per patient days in September and October 2021 were also lower than the same months in 2019 and 2020 (Figure 1). The number of lab draws per patient days did not differ after the intervention (August-October 2021), when compared to trends from prior years (Figure 2).
Conclusions: A reduction in laboratory charges per patient days was achieved after a multifaceted education-focused intervention. Decrease in charges but not in number of lab draws may reflect the project’s focus on decreasing charges rather than on other metrics. Follow-up analysis will need to be performed to assess the longevity of our interventions. However, our study shows that in the short-term our intervention was successful in decreasing overall lab charges. Future directions include interventions to decrease the number of lab draws, or a focus on secondary benefits, such as decreased blood transfusions or painful procedures.
