title: A Multidisciplinary Housestaff-Led Initiative to Safely Reduce Daily Laboratory Testing.
abstract: Provision of high-value care is a milestone in physician training. The authors evaluated the effect of a housestaff-led initiative on laboratory testing rates.
  
  
  
  Vanderbilt University Medical Center's Choosing Wisely steering committee, led by housestaff with faculty advisors, sought to reduce unnecessary daily basic metabolic panel (BMP) and complete blood count (CBC) testing on inpatient general medicine and surgical services. Intervention services received a didactic session followed by regular data feedback with goal rates and peer comparison. Testing rates during January 1, 2013-February 9, 2015, were compared on intervention services and control services using a difference-in-differences analysis and an interrupted time-series analysis with segmented linear regression.
  
  
  
  Compared with concurrent controls, the mean number of BMP tests per patient day decreased by an additional 0.23 (95% CI 0.17-0.29) on medical housestaff and 0.15 (95% CI 0.09-0.21) on hospitalist intervention services. Daily CBC tests decreased by an additional 0.28 (95% CI 0.23-0.33) on medical housestaff, 0.08 (95% CI 0.03-0.13) on hospitalist, and 0.12 (95% CI 0.05-0.20) on surgical housestaff intervention services. Patients with lab-free days (0 labs ordered in 24 hours) increased by an additional 4.1 percentage points (95% CI 2.1-6.1) on medical housestaff and 9.7 percentage points (95% CI 6.6-12.8) on hospitalist intervention services. There were no adverse changes in length of stay or intensive care unit transfer, in-hospital mortality, or 30-day readmission rates.
  
  
  
  A housestaff-led intervention utilizing education and data feedback with goal setting and peer comparison resulted in safe, significant reductions in daily laboratory testing rates.
authors.affiliation: W. Iams is chief resident in internal medicine, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. J. Heck was chief resident in radiology and musculoskeletal radiology fellow, Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, at the time of implementation and writing. M. Kapp is chief resident in pathology, Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee. D. Leverenz is a third-year internal medicine resident, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. M. Vella is a fourth-year general surgery resident, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. E. Szentirmai is a fourth-year medical student, School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. I. Valerio-Navarrete is data analyst, Department of Informatics, Vanderbilt University Medical Center, Nashville, Tennessee. C. Theobald is assistant professor of medicine, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. K. Goggins is research coordinator, Department of Internal Medicine and Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee. K. Flemmons is assistant professor of medicine, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. K. Sponsler is assistant professor of medicine, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. C. Penrod is a pediatric emergency medicine fellow, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee. P. Kleinholz is chief resident in neurology, Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee. D. Brady is professor of medicine and designated institutional official, Office of Graduate Medical Education,
authors.forename: Wade
authors.initials: W
authors.lastname: Iams
authors.forename: Josh
authors.initials: J
authors.lastname: Heck
authors.forename: Meghan
authors.initials: M
authors.lastname: Kapp
authors.forename: David
authors.initials: D
authors.lastname: Leverenz
authors.forename: Michael
authors.initials: M
authors.lastname: Vella
authors.forename: Eszter
authors.initials: E
authors.lastname: Szentirmai
authors.forename: Irene
authors.initials: I
authors.lastname: Valerio-Navarrete
authors.forename: Cecelia
authors.initials: C
authors.lastname: Theobald
authors.forename: Kathryn
authors.initials: K
authors.lastname: Goggins
authors.forename: Kevin
authors.initials: K
authors.lastname: Flemmons
authors.forename: Kelly
authors.initials: K
authors.lastname: Sponsler
authors.forename: Cody
authors.initials: C
authors.lastname: Penrod
authors.forename: Patricia
authors.initials: P
authors.lastname: Kleinholz
authors.forename: Donald
authors.initials: D
authors.lastname: Brady
authors.forename: Sunil
authors.initials: S
authors.lastname: Kripalani
mesh_terms: D019411:Clinical Laboratory Techniques / Q000706:statistics & numerical data*; D004502:Education, Medical, Continuing / Q000379:methods / Q000458:organization & administration; D005180:Faculty, Medical / Q000458:organization & administration*; D020445:Hospitalists / Q000458:organization & administration*; D006801:Humans; D033183:Interdisciplinary Communication; D007396:Internship and Residency / Q000379:methods / Q000458:organization & administration*; D007857:Leadership; D016014:Linear Models; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013714:Tennessee; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*