Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada.
Department of Anesthesia, Pharmacology and Therapeutics, Therapeutics Initiative, University of British Columbia, Vancouver, V6T 1Z4, Canada.
Implement Sci. 2024 Jul 2;19(1):45. doi: 10.1186/s13012-024-01376-6.
Laboratory test overuse in hospitals is a form of healthcare waste that also harms patients. Developing and evaluating interventions to reduce this form of healthcare waste is critical. We detail the protocol for our study which aims to implement and evaluate the impact of an evidence-based, multicomponent intervention bundle on repetitive use of routine laboratory testing in hospitalized medical patients across adult hospitals in the province of British Columbia, Canada.
We have designed a stepped-wedge cluster randomized trial to assess the impact of a multicomponent intervention bundle across 16 hospitals in the province of British Columbia in Canada. We will use the Knowledge to Action cycle to guide implementation and the RE-AIM framework to guide evaluation of the intervention bundle. The primary outcome will be the number of routine laboratory tests ordered per patient-day in the intervention versus control periods. Secondary outcome measures will assess implementation fidelity, number of all common laboratory tests used, impact on healthcare costs, and safety outcomes. The study will include patients admitted to adult medical wards (internal medicine or family medicine) and healthcare providers working in these wards within the participating hospitals. After a baseline period of 24 weeks, we will conduct a 16-week pilot at one hospital site. A new cluster (containing approximately 2-3 hospitals) will receive the intervention every 12 weeks. We will evaluate the sustainability of implementation at 24 weeks post implementation of the final cluster. Using intention to treat, we will use generalized linear mixed models for analysis to evaluate the impact of the intervention on outcomes.
The study builds upon a multicomponent intervention bundle that has previously demonstrated effectiveness. The elements of the intervention bundle are easily adaptable to other settings, facilitating future adoption in wider contexts. The study outputs are expected to have a positive impact as they will reduce usage of repetitive laboratory tests and provide empirically supported measures and tools for accomplishing this work.
This study was prospectively registered on April 8, 2024, via ClinicalTrials.gov Protocols Registration and Results System (NCT06359587). https://classic.
gov/ct2/show/NCT06359587?term=NCT06359587&recrs=ab&draw=2&rank=1.
医院实验室检测过度是一种医疗废物形式，也会对患者造成伤害。开发和评估减少这种医疗废物形式的干预措施至关重要。我们详细介绍了我们的研究方案，该方案旨在实施并评估基于证据的多组分干预措施包对加拿大不列颠哥伦比亚省成人医院住院医疗患者重复常规实验室检测的影响。
我们设计了一个阶梯式楔形集群随机试验，以评估该多组分干预措施包在加拿大不列颠哥伦比亚省 16 家医院的影响。我们将使用知识转化周期来指导实施，使用 RE-AIM 框架来指导干预措施包的评估。主要结果将是干预期和对照期每位患者每天常规实验室检测的数量。次要结果指标将评估实施的保真度、使用的所有常见实验室检测的数量、对医疗保健成本的影响和安全结果。该研究将包括入住成人内科病房（内科或家庭医学）的患者和参与医院内科病房工作的医疗保健提供者。在 24 周的基线期后，我们将在一个医院地点进行 16 周的试点。每 12 周，一个新的集群（包含大约 2-3 家医院）将接受干预。在最后一个集群实施后 24 周，我们将评估实施的可持续性。使用意向治疗，我们将使用广义线性混合模型进行分析，以评估干预对结果的影响。
该研究建立在先前已证明有效的多组分干预措施包的基础上。干预措施包的要素易于适应其他环境，便于在更广泛的背景下采用。研究结果预计会产生积极影响，因为它们将减少重复实验室检测的使用，并提供经验支持的措施和工具来完成这项工作。
该研究于 2024 年 4 月 8 日通过临床试验注册和结果系统（ClinicalTrials.gov Protocols Registration and Results System）前瞻性注册（NCT06359587）。https://classic.clinicaltrials.gov/ct2/show/NCT06359587?term=NCT06359587&recrs=ab&draw=2&rank=1。
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