AJCP Study Shows How to Improve Patient Care, Prevent Unnecessary Tests, and Save Money

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Test Utilization Committee and Computerized Physician Order Entry System at Cleveland Clinic Provide Successful Model

This is a real-world example of how we can reduce unnecessary testing and open the lines of communication between clinicians and laboratory professionals to provide better care for patients.

A program at Cleveland Clinic reduced the number of unnecessary lab tests by blocking physicians from ordering the same test for hospitalized patients more than once a day. According to a recent study in the American Journal of Clinical Pathology, published by the American Society for Clinical Pathology (ASCP), the initiative prevented nearly 12,000 unnecessary tests over a two-year period.

The program aimed to improve patient satisfaction by preventing unnecessary needle sticks, as well as to reduce anemia caused by excess blood draws. As an added benefit, the reduction in tests resulted in a cost savings of more than $183,000.

The initiative focused on implementation of a clinical decision support tool that was incorporated in the system’s computerized physician order entry (CPOE) program. The tool prevented physicians from ordering a test if it had already been ordered that day, and then provided the results of the earlier test. This was only done for tests deemed never to be needed more than once per day by a multidisciplinary test utilization committee. While many hospitals use a CPOE system that alerts the doctor that a test has already been ordered, physicians often ignore it because they don’t have the results handy, or the time to track them down, researchers said.

“The difference in our program is that we provided a ‘hard stop,’ meaning the system won’t allow doctors to order the duplicate tests, and even more importantly, the program provides the result of the test that had been previously ordered,” said Gary W. Procop, MD, MS, FASCP, author of the study, pathologist and medical director of enterprise test utilization and consultation services at Cleveland Clinic. “Doctors appreciated that. One told me that he was thrilled that computers were finally helping him do a better job.”

In the study, researchers determined the program blocked the ordering of 11,790 unnecessary tests over two years, resulting in $183,586 savings in materials and labor for laboratory personnel. Researchers did not calculate the cost savings of fewer needle sticks or specimen processing, transport, processing or the need for the health care provider to review and act on the test results, meaning the actual savings were likely far greater, they said. If a doctor truly felt the repeated test was necessary, he or she could call the laboratory’s 24-hour client services department to request an override. In the two-year study, doctors made such requests only 414 times, and all were granted.

The initiative included 1,259 common tests, ranging from one that gauges levels of vitamin D in the blood to another that tests for the Clostridium difficile bacteria.

Blocking duplicate tests prevents patients from undergoing unnecessary and uncomfortable phlebotomy – in which a needle is placed in the arm and blood for tests is drawn through it into test tubes. Patients such as those who are hospitalized and repeatedly have blood drawn are at higher risk for anemia.

Prior to implementation, the Cleveland Clinic initiative was vetted by the entire medical staff, which weighed in on what tests were commonly ordered and provided feedback after the first phase of the roll-out. “The key to success is team building, which lets doctors who treat patients know we in the laboratory are on their side, and want to implement a system that works for them and improves health care,” said Dr. Procop.

“This dovetails perfectly with ASCP’s participation in the Choosing Wisely campaign to reduce unnecessary tests and procedures,” said Steven H. Kroft, MD, FASCP, ASCP president and vice chair for clinical pathology and director of hematopathology at the Medical College of Wisconsin at Milwaukee. “Laboratory professionals are the experts in lab testing and should be driving these programs. This is a real-world example of how we can reduce unnecessary testing and open the lines of communication between clinicians and laboratory professionals to provide better care for patients.”

More than 60 leading medical specialty societies, including ASCP, have joined the Choosing Wisely Campaign—an initiative of the ABIM Foundation—since its inception in 2012. The societies have released evidence-based lists of tests and procedures that may not be properly utilized for all patients. The lists provide targeted, evidence-based interventions to help physicians and patients have conversations about making wise choices about their care to avoid inappropriate tests that provide no benefit.

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About ASCP
Founded in 1922 in Chicago, ASCP is a medical professional society with more than 100,000 member board-certified anatomic and clinical pathologists, pathology residents and fellows, laboratory professionals, and students. ASCP provides excellence in education, certification, and advocacy on behalf of patients, pathologists, and laboratory professionals. To learn more, visit http://www.ascp.org. Follow us on Twitter at http://www.twitter.com/ascp_chicago and connect with us on Facebook at http://www.facebook.com/ASCP.Chicago.

About Cleveland Clinic
Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. Located in Cleveland, Ohio, it was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States. U.S.News & World Report consistently names Cleveland Clinic as one of the nation’s best hospitals in its annual “America’s Best Hospitals” survey. More than 3,000 full-time salaried physicians and researchers and 11,000 nurses represent 120 medical specialties and subspecialties. The Cleveland Clinic health system includes a main campus near downtown Cleveland, eight community hospitals, more than 75 Northern Ohio outpatient locations, including 16 full-service Family Health Centers, Cleveland Clinic Florida, the Lou Ruvo Center for Brain Health in Las Vegas, Cleveland Clinic Canada, and, currently under construction, Cleveland Clinic Abu Dhabi. In 2012, there were 5.1 million outpatient visits throughout the Cleveland Clinic health system and 157,000 hospital admissions. Patients came for treatment from every state and from more than 130 countries. Visit us at http://www.clevelandclinic.org. Follow us at http://www.twitter.com/ClevelandClinic.

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