Scholarlink

Background <p>Routine lab testing of stable inpatients represents low-value care and contributes toward healthcare’s significant carbon footprint. If the US healthcare system was its own nation, it would be the 13th largest emitter of greenhouse gases. Integrating the concepts of high-value care and environmental sustainability represents a potentially new approach to reduce unnecessary lab testing, low-value care, and carbon emissions.</p> Objective <p>To assess if an intervention integrating concepts of environmental sustainability and high-value care can influence resident lab ordering practices.</p> Design <p>We conducted a 6-month concurrent control versus intervention pilot. Statistical analysis consisted of matched-pair propensity score analysis and Wilcoxon rank-sum test.</p> Participants <p>Two medicine teams with equal composition of attending and resident physicians at an urban academic tertiary care center.</p> Interventions <p>Intervention team received (1) a video on the negative effects of unnecessary testing, including adverse environmental impacts; (2) daily team-based reviews of lab orders; and (3) reminder emails about team-based reviews. Intervention team residents received quantitative surveys to assess ordering behaviors.</p> Main Measures <p>Primary outcomes were the average number of both basic lab tests and venipunctures per patient per day. Secondary outcomes included kilograms of carbon dioxide (CO<sub>2</sub>) saved and resident perceptions of ordering practices.</p> Key Results <p>Control and intervention patients, respectively, had on average 3.91 versus 3.62 labs per patient day (<i>p</i> &lt; 0.001) and 1.39 versus 1.32 venipunctures per patient day (<i>p</i> = 0.003). An estimated 81&#xa0;kg CO<sub>2</sub> was saved. The proportion of surveyed residents who assessed clinical lab indications at least multiple times weekly or daily increased from 47.8% pre-intervention to 86.9% post-intervention (<i>p</i> = 0.03).</p> Conclusion <p>An intervention integrating high-value care and environmental sustainability changed resident ordering behavior, producing fewer lab tests and venipunctures and a smaller carbon footprint. This approach represents an additional modality to reduce unnecessary laboratory testing and low-value care.</p> Graphical Abstract <p></p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Integrating High-Value Care and Environmental Sustainability to Reduce Unnecessary Laboratory Testing by Residents: An Interventional Pilot

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年8月4日

查看全文
  • Peter Trinh,
  • Joshua E. Lewis,
  • Julie Fiskio,
  • Jeffrey L. Schnipper,
  • Paul F. Dellaripa,
  • Herrick Fisher

摘要

Background

Routine lab testing of stable inpatients represents low-value care and contributes toward healthcare’s significant carbon footprint. If the US healthcare system was its own nation, it would be the 13th largest emitter of greenhouse gases. Integrating the concepts of high-value care and environmental sustainability represents a potentially new approach to reduce unnecessary lab testing, low-value care, and carbon emissions.

Objective

To assess if an intervention integrating concepts of environmental sustainability and high-value care can influence resident lab ordering practices.

Design

We conducted a 6-month concurrent control versus intervention pilot. Statistical analysis consisted of matched-pair propensity score analysis and Wilcoxon rank-sum test.

Participants

Two medicine teams with equal composition of attending and resident physicians at an urban academic tertiary care center.

Interventions

Intervention team received (1) a video on the negative effects of unnecessary testing, including adverse environmental impacts; (2) daily team-based reviews of lab orders; and (3) reminder emails about team-based reviews. Intervention team residents received quantitative surveys to assess ordering behaviors.

Main Measures

Primary outcomes were the average number of both basic lab tests and venipunctures per patient per day. Secondary outcomes included kilograms of carbon dioxide (CO2) saved and resident perceptions of ordering practices.

Key Results

Control and intervention patients, respectively, had on average 3.91 versus 3.62 labs per patient day (p < 0.001) and 1.39 versus 1.32 venipunctures per patient day (p = 0.003). An estimated 81 kg CO2 was saved. The proportion of surveyed residents who assessed clinical lab indications at least multiple times weekly or daily increased from 47.8% pre-intervention to 86.9% post-intervention (p = 0.03).

Conclusion

An intervention integrating high-value care and environmental sustainability changed resident ordering behavior, producing fewer lab tests and venipunctures and a smaller carbon footprint. This approach represents an additional modality to reduce unnecessary laboratory testing and low-value care.

Graphical Abstract