Multifaceted intervention including education, rounding checklist implementation, cost feedback, and financial incentives reduces inpatient laboratory costs

BACKGROUND Inappropriate laboratory testing is a contributor to waste in healthcare. OBJECTIVE To evaluate the impact of a multifaceted laboratory reduction intervention on laboratory costs. DESIGN A retrospective, controlled, interrupted time series (ITS) study. SETTING University of Utah Health Care, a 500-bed academic medical center in Salt Lake City, Utah. POPULATION All patients 18 years or older admitted to the hospital to a service other than obstetrics, rehabilitation, or psychiatry. INTERVENTION Multifaceted quality-improvement initiative in a hospitalist service including education, process change, cost feedback, and financial incentive. MEASUREMENTS Primary outcomes of lab cost per day and per visit. Secondary outcomes of number of basic metabolic panel (BMP), comprehensive metabolic panel (CMP), complete blood count (CBC), and prothrombin time/international normalized ratio tests per day; length of stay (LOS); and 30-day readmissions. RESULTS A total of 6310 hospitalist patient visits (intervention group) were compared to 25,586 nonhospitalist visits (control group). Among the intervention group, the unadjusted mean cost per day was reduced from $138 before the intervention to $123 after the intervention (P < 0.001), and the unadjusted mean cost per visit decreased from $618 to $558 (P = 0.005). The ITS analysis showed significant reductions in cost per day, cost per visit, and the number of BMP, CMP, and CBC tests per day (P = 0.034, 0.02, <0.001, 0.004, and <0.001). LOS was unchanged and 30-day readmissions decreased in the intervention group. CONCLUSION A multifaceted approach to laboratory reduction demonstrated a significant reduction in laboratory cost per day and per visit, as well as common tests per day at a major academic medical center. Journal of Hospital Medicine 2016;11:348–354. © 2016 Society of Hospital Medicine