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

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.