Medicine, University of Calgary Cumming School of Medicine, Calgary, Canada
Ward of the 21st Century, University of Calgary Cumming School of Medicine, Calgary, Canada.
BMJ Qual Saf. 2023 Sep;32(9):517-525. doi: 10.1136/bmjqs-2022-015611. Epub 2023 May 10.
Low-value use of laboratory tests is a global challenge. Our objective was to evaluate an intervention bundle to reduce repetitive use of routine laboratory testing in hospitalised patients.
We used a stepped-wedge design to implement an intervention bundle across eight medical units. Our intervention included educational tools and social comparison reports followed by peer-facilitated report discussion sessions. The study spanned October 2020-June 2021, divided into control, feasibility testing, intervention and a follow-up period. The primary outcomes were the number and costs of routine laboratory tests ordered per patient-day. We used generalised linear mixed models, and analyses were by intention to treat.
We included a total of 125 854 patient-days. Patient groups were similar in age, sex, Charlson Comorbidity Index and length of stay during the control, intervention and follow-up periods. From the control to the follow-up period, there was a 14% (incidence rate ratio (IRR)=0.86, 95% CI 0.79 to 0.92) overall reduction in ordering of routine tests with the intervention, along with a 14% (β coefficient=-0.14, 95% CI -0.07 to -0.21) reduction in costs of routine testing. This amounted to a total cost savings of $C1.15 per patient-day. There was also a 15% (IRR=0.85, 95% CI 0.79, 0.92) reduction in ordering of all common tests with the intervention and a 20% (IRR=1.20, 95% CI 1.10 to 1.30) increase in routine test-free patient-days. No worsening was noted in patient safety endpoints with the intervention.
A multifaceted intervention bundle using education and facilitated multilevel social comparison was associated with a safe and effective reduction in use of routine daily laboratory testing in hospitals. Further research is needed to understand how system-level interventions may increase this effect and which intervention elements are necessary to sustain results.
实验室检测的低值使用是一个全球性的挑战。我们的目标是评估一套干预措施，以减少住院患者常规实验室检测的重复使用。
我们使用阶梯式楔形设计在 8 个医疗单位实施干预措施。我们的干预措施包括教育工具和社会比较报告，然后是同伴促进的报告讨论环节。研究于 2020 年 10 月至 2021 年 6 月进行，分为对照组、可行性测试期、干预期和随访期。主要结局是每位患者每天的常规实验室检测次数和成本。我们使用广义线性混合模型，分析按意向治疗进行。
我们共纳入了 125854 个患者日。在对照组、干预组和随访组中，患者组的年龄、性别、Charlson 合并症指数和住院时间相似。从对照组到随访期，常规检测的总检测次数减少了 14%（发生率比（IRR）=0.86，95%CI 0.79 至 0.92），常规检测的成本也减少了 14%（β系数=-0.14，95%CI -0.07 至 -0.21）。这相当于每位患者每天节省 1.15 加元的费用。与干预组相比，所有常见检测的检测次数减少了 15%（IRR=0.85，95%CI 0.79，0.92），常规检测无检测天数增加了 20%（IRR=1.20，95%CI 1.10 至 1.30）。干预组患者安全终点未见恶化。
使用教育和促进多层次社会比较的综合干预措施，与安全有效的减少医院常规日常实验室检测的使用有关。需要进一步研究以了解系统干预措施如何增加这种效果，以及哪些干预措施是维持结果所必需的。
Zotero 插件