Results of a Quality Improvement Project Aimed at Eliminating Healthcare Waste by Changing Medical Resident Test Ordering Behavior
Sushilkumar Satish GuptaRadhika VoletiVimbai NyembaSelma DemırOlaoluwatomi LamikanraNomsa MusemwaAngela SaverimuthuKamaldeen AgoroRobert KalterPeter HomelMelvyn HechtLawrence WolfEdward K. ChapnickMichael KantrowitzStephan L. Kamholz
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Background: In light of rising healthcare costs and evidence of inefficient use of medical resources, there is growing interest in reducing healthcare waste by clinicians. Unwarranted lab tests may lead to further tests, prolonged hospital stays, unnecessary referrals and procedures, patient discomfort, and iatrogenic anemia, resulting in significant economic and clinical effects. Blood tests are essential in guiding medical decisions, but they are also associated with significant financial and clinical costs. We designed a quality improvement study that attempted to decrease inappropriate ordering of laboratory tests while maintaining quality of care in a large residency program. Methods: An algorithm outlining indications for complete blood count (CBC), coagulation profile (PT/INR) and basic metabolic profile (BMP) was created by the study team. Data from 1,312 patients over a 3-month period in the pre-intervention phase and 1,255 patients during the selected intervention phase were analyzed. The primary endpoint was mortality rate and secondary endpoints were length of stay and laboratory costs. Results: There were significant decreases in the number of PT/INR orders (20.6%), followed by BMP orders (12.4%), and CBC orders (9.3%). The mortality rate was 5.3% for the pre-intervention phase and 5.8% for the selected intervention phase, with a difference of 0.5% (P = 0.44). Conclusion: Our approach leads to a decrease in costs, preventing unnecessary downstream testing, and improving patient experience. It also brought a mental discipline while ordering blood tests amongst residents. J Clin Med Res. 2017;9(12):965-969 doi: https://doi.org/10.14740/jocmr3210wKeywords:
Clinical endpoint
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In this paper, problems connected to the adaptation of EU cereal intervention in Hungary are discussed. Statistical evidence is provided about the two record years of intervention in Hungary proving that farmers did not take part in intervention though the system was sought to be tailored to farmers' needs. Intervention purchases took place at the wholesale level and traders were the most active participants in both intervention periods. This dynamic intervention activity of traders will significantly alter the Hungarian trade sector by bringing it closer to the physical processes of the cereal chain. As to the size of intervention, the great volume of the purchase of maize has resulted in an exceptionally severe problem considering the large surplus of Hungarian cereals. Recently, the Commission hampered maize intervention in Hungary by excluding this crop from cereals eligible for intervention. This measure is criticised in the paper, as we deem it unnecessary in recent market conditions, and in our view it doesn't make up the compulsory need for a complex reconsideration of recent EU cereal policy on the long term.
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