https://orcid.org/0000-0002-3367-8497
Healthcare costs have been rising and are projected to increase to $5.4 trillion by 2024.Citation1 Interventions aimed at providing cost-effective and high-value care have recently been the focus of many national campaigns. The Choosing Wisely campaign is one such intervention. The American Board of Internal Medicine and the American College of Physicians launched this campaign to encourage cost-effective care implementation and reduce the pervasive problem of low-value care, which is estimated to cost $750 billion per year without improving health outcomes.Citation1 Given the importance of safety net hospitals to the healthcare safety net in the US, interventions that lead to significant and safe reductions in healthcare expenditure become extremely necessary. We sought to reduce clinical waste by optimizing laboratory utilization at John H. Stroger Jr. Hospital of Cook County, to help reduce our overall healthcare expenditure.
We identified frequent daily low-cost lab orders that were not clinically indicated on a frequent/daily basis, identified commonly ordered but uncommonly useful tests, and identified high-cost item orders that were not indicated. Interventions included institution-wide presentations outlining the problem of waste specific to our hospital, in addition to department-specific presentations outlining identified areas of inpatient waste and customized strategies to deploy. Presentations were geared toward housestaff and attendings within each department and were conducted at the start of every inpatient rotation. Housestaff were encouraged to include justification for all tests ordered in daily progress notes. We employed real-time nonelectronic reminders with Choosing Wisely laboratory recommendations. We also employed electronic reminders to alert physicians to laboratory investigations already ordered within 24 hours as well as order lockouts that required physician justification. Audits were done randomly, and accolades were given to the most compliant team. After these interventions, we measured utilization rates by all departments at 3, 9, 12, and 18 months and compared them to the baseline lab utilization.
Three months after the intervention, we noted a significant drop in laboratory orders from 116,540 to 47,871. This equated to a 60% reduction in laboratory utilization. At 10 months postintervention, there was a sustained 63% reduction in laboratory utilization. At 18 months postintervention, there was a sustained 54% reduction in laboratory utilization ().
Figure 1. Laboratory utilization from the prepandemic through the pandemic period and the effect of an educational intervention postpandemic.
Overall, our multifaceted intervention led to a significant reduction in laboratory utilization, freeing up resources for other important healthcare interventions. The educational interventions including cost-awareness strategies utilized during this study have been found to be effective in other healthcare institutions.Citation2 It is imperative to continue these interventions with new physician hires to reinforce the institutional culture of Choosing Wisely, as this leads to improved outcomes and reduction in overall healthcare costs.
Cook County Health, Chicago, Illinois USA
[email protected]
http://orcid.org/0000-0002-3367-8497
http://orcid.org/0000-0001-9743-235X
- Keehan SP, Cuckler GA, Sisko AM, et al. National health expenditure projections, 2014–24: spending growth faster than recent trends. Health Aff. 2015;34:1407–1417.
- Moriates C, Mourad M, Novelero M, Wachter RM. Development of a hospital-based program focused on improving healthcare value. J Hosp Med. 2014;9:671–677.