Milestone 2 Summary

Definition: Practice has reduced unnecessary tests, as defined by the practice


 What does success look like?

0

1 2

3

Practice has not reduced unnecessary tests or does not have baseline data on this measure. Practice has identified the tests it will focus on for reduction and the corresponding metrics it will monitor and manage. Practice has established a baseline, is regularly monitoring its identified metrics, but improvement has not yet been demonstrated. Practice has demonstrated improvement in reducing unnecessary tests.

Note: Numbers are PAT Scores


Why is this important?

In the United States healthcare costs are the rise exponentially1 and one of the major contributors is laboratory testing.2 A study looking at laboratory ordering patterns found 70% of residents self-reported ordering unnecessary labs.3 Many tests require additional time and resources from patients to fulfill and can have negative consequences. For example, hospitalized patients who experience unnecessary testing during their stay have an increased risk of developing iatrogenic anemia which can delay healing of wounds and increase infection rates.4 In addition to the burden placed on patients when requested to oblige to excessive testing, these practices can be very costly. One study estimated an average $2,488 per patient charge associated with unnecessary cardiac and/or neurological testing for pediatric syncope alone.5 Many initiatives, such as Choosing Wisely, aim to reduce unnecessary testing and provide guidance on appropriate testing to target for reduction. 


Potential Tactics 6,7

  • Review your specialty’s Choosing Wisely recommendations to identify areas for improvement in unnecessary testing
  • Consciously consider and review the clinical necessity for repeated or standard orders
  • Do not repeat large panel testing to address a disturbance of one or two lab values
  • Educate your providers and staff on costs associated with testing
  • Use laboratory management systems or clinician reminders in your EHR to help minimize ordering of unnecessary tests 

Tools and Resources


What might this look like in practice?

Case Study A: Coming Face-to-Face with Unneeded Tests

Case Study B: Addressing the Learning Curve


References

  1. Sisko, Andrea, et al. “Health spending projections through 2018: recession effects add uncertainty to the outlook.” Health Affairs 28.2 (2009): w346-w357.Advances in Quality Improvement: Principles and Framework, Spring 2001 issue of the Quality Assurance Project’s QA Brief.
  2. Konger, Raymond L., et al. “Reduction in Unnecessary Clinical Laboratory Testing Through Utilization Management at a US Government Veterans Affairs Hospital.” American journal of clinical pathology (2016): aqv092.\
  3. Nachamkin, Irving. “How many lab tests do patients really need?” Pepper Talk – Perelman School of Medicine – University of Pennsylvania, 29 September 2015. Available at: http://pathology.med.upenn.edu/department/blogs/pepper-talk/how-many-lab-tests-do-patients-really-need
  4. Procop, Gary. “Curbing Unnecessary Lab Tests.” American Association of Clinical Chemists (AACC) Lab Solution Summit,  6 Aug 2015. Available at: https://www.aacc.org/publications/cln/cln-stat/2015/august/6/curbing-unnecessary-lab-tests.aspx
  5. Redd C, Thomas C, Willis M, Amos M, Anderson J. Cost of Unnecessary Testing in the Evaluation of Pediatric Syncope. Pediatr Cardiol. 2017 May 18.
  6. Konger, Raymond L., et al. “Reduction in Unnecessary Clinical Laboratory Testing Through Utilization Management at a US Government Veterans Affairs Hospital.” American journal of clinical pathology (2016): aqv092.
  7. Procop, Gary. “Curbing Unnecessary Lab Tests.” American Association of Clinical Chemists (AACC) Lab Solution Summit,  6 Aug 2015. Available at: https://www.aacc.org/publications/cln/cln-stat/2015/august/6/curbing-unnecessary-lab-tests.aspx
  8.