title: Targeted reduction in neurosurgical laboratory utilization: resident-led effort at a single academic institution.
abstract: OBJECTIVE
  Given economic limitations and burgeoning health care costs, there is a need to minimize unnecessary diagnostic laboratory tests.
  
  
  METHODS
  The authors studied whether a financial incentive program for trainees could lead to fewer unnecessary laboratory tests in neurosurgical patients in a large, 600-bed academic hospital setting. The authors identified 5 laboratory tests that ranked in the top 13 of the most frequently ordered during the 2010-2011 fiscal year, yet were least likely to be abnormal or influence patient management.
  
  
  RESULTS
  In a single year of study, there was a 47% reduction in testing of serum total calcium, ionized calcium, chloride, magnesium, and phosphorus. This reduction led to a savings of $1.7 million in billable charges to health care payers and $75,000 of direct costs to the medical center. In addition, there were no significant negative changes in the quality of care delivered, as recorded in a number of metrics, showing that this cost savings did not negatively impact patient care.
  
  
  CONCLUSIONS
  Engaging physician trainees in quality improvement can be successfully achieved by financial incentives. Through the resident-led quality improvement incentive program, neurosurgical trainees successfully reduced unnecessary laboratory tests, resulting in significant cost savings to both the medical center and the health care system. Similar programs that engage trainees could improve the value of care being provided at other academic medical centers.
authors.affiliation: Department of Neurological Surgery and.
authors.forename: Seunggu J
authors.initials: SJ
authors.lastname: Han
authors.forename: Rajiv
authors.initials: R
authors.lastname: Saigal
authors.forename: John D
authors.initials: JD
authors.lastname: Rolston
authors.forename: Jason S
authors.initials: JS
authors.lastname: Cheng
authors.forename: Catherine Y
authors.initials: CY
authors.lastname: Lau
authors.forename: Rita I
authors.initials: RI
authors.lastname: Mistry
authors.forename: Michael W
authors.initials: MW
authors.lastname: McDermott
authors.forename: Mitchel S
authors.initials: MS
authors.lastname: Berger
mesh_terms: D000046:Academic Medical Centers / Q000191:economics*; D017046:Cost Savings / Q000191:economics*; D003955:Diagnostic Tests, Routine / Q000191:economics / Q000706:statistics & numerical data*; D017048:Health Care Costs; D006801:Humans; D007396:Internship and Residency; D009493:Neurosurgery / Q000191:economics; D058996:Quality Improvement / Q000191:economics*; D019564:Unnecessary Procedures / Q000191:economics*