Department of Internal Medicine, Spectrum Health-Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
Department of Internal Medicine, Spectrum Health-Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA.
Postgrad Med J. 2018 Dec;94(1118):716-719. doi: 10.1136/postgradmedj-2018-135784. Epub 2019 Jan 22.
The Choosing Wisely guidelines advise against ordering routine blood tests for hospitalised patients unless they change management. Unnecessary testing can lead to adverse effects (eg, iatrogenic anaemia, poor sleep quality, risk for infections and increased cost of care).
An 8-week quality initiative aimed at reducing unnecessary blood tests was implemented in three internal medicine resident inpatient services. The initiative included a 30 min educational session, reminders prior to rotation and midrotation and posters in work areas that displayed lab pricing and urged judicious testing. Residents were encouraged to justify the purpose of ordering tests in their daily progress notes. Attending physicians were made aware of the initiative. Preintervention and postintervention time points were used to compare key metrics. A >10% decrease between time periods was used as an evaluation criterion.
There were 293 patient records reviewed in the preintervention period and 419 in the postintervention period. The two groups were similar in terms of age and gender. Median blood test count (complete blood count/basic metabolic profile/comprehensive metabolic profile) decreased from 4 to 2 tests per patient per day (50 % decrease) after the intervention. The median length of hospital stay decreased from 4.9 to 3.9 days (21% decrease). A decreased percentage of people requiring transfusions was also noted (2016: 6.1%, 2017: 2.9%).
The frequency of unnecessary routine blood tests ordered in the hospital can be decreased by educating resident physicians, making them cost conscious and aware of the indications for ordering routine labs. Frequent reminders are needed to sustain the educational benefit.
选择明智指南建议，除非改变管理方式，否则不应为住院患者常规开具血液检查。不必要的检查会导致不良后果（例如，医源性贫血、睡眠质量差、感染风险增加和医疗费用增加）。
在三个内科住院医师住院服务中实施了一项为期 8 周的质量倡议，旨在减少不必要的血液检查。该倡议包括 30 分钟的教育课程、在轮岗前和轮中提醒以及在工作区域张贴的海报，这些海报显示了实验室的定价，并敦促进行明智的检查。住院医师被鼓励在日常进展记录中说明检查目的。告知主治医生该倡议。使用干预前后的时间点来比较关键指标。如果两个时间段之间的降幅超过 10%，则作为评估标准。
在干预前期间审查了 293 份患者记录，在干预后期间审查了 419 份患者记录。两组在年龄和性别方面相似。干预后，每位患者每天的血液检查次数（全血细胞计数/基本代谢谱/综合代谢谱）从 4 次减少到 2 次（减少 50%）。住院时间中位数从 4.9 天减少到 3.9 天（减少 21%）。还注意到需要输血的人数百分比也有所下降（2016 年：6.1%，2017 年：2.9%）。
通过教育住院医师、使他们具有成本意识并了解常规实验室检查的适应证，可以减少医院中不必要的常规血液检查的频率。需要频繁提醒以维持教育效果。
