title: Teaching residents systems-based practice through a hospital cost-reduction program: a "win-win" situation.
abstract: BACKGROUND
  The Accreditation Council for Graduate Medical Education (ACGME) Outcome Project challenges residency programs to teach and evaluate competence in 6 domains, including systems-based practice (SBP). One element of SBP is to "practice cost-effective health care ... that does not compromise quality." Institutional cost-reduction efforts included targeting laboratory fees by using point-of-care testing with an iSTAT machine rather than in the central laboratory. Predicted cost savings were 50,000 US dollars per month. Because residents are primary users of laboratory resources, the authors engaged them in the process and implementation of system redesign.
  
  
  METHODS
  The residents identified barriers to use of the iSTAT and solutions to overcome those barriers.
  
  
  RESULTS
  As a result of resident solutions, use of the iSTATwent from 40% of potential iSTATtests being ordered on the iSTAT to 98%, with an estimated 549,780 US dollars per year in savings to the hospital.
  
  
  CONCLUSIONS
  Involving residents in hospital cost-reduction efforts allows both teaching and evaluation of competence in SBP while realizing significant cost savings.
authors.affiliation: Department of Pediatrics, University of Connecticut School of Medicine, Hartford, USA. Renglan@ccmckids.org
authors.forename: Robert
authors.initials: R
authors.lastname: Englander
authors.forename: William
authors.initials: W
authors.lastname: Agostinucci
authors.forename: Edwin
authors.initials: E
authors.lastname: Zalneraiti
authors.forename: Carol L
authors.initials: CL
authors.lastname: Carraccio
mesh_terms: D019411:Clinical Laboratory Techniques / Q000191:economics; D003363:Cost Control / Q000379:methods; D004503:Education, Medical, Graduate; D017721:Hospital Costs; D006776:Hospitals, Pediatric; D006801:Humans; D007396:Internship and Residency; D009820:Ohio; D019095:Point-of-Care Systems / Q000706:statistics & numerical data*