Educational Intervention Reduces Utilization Of Low-Value Testing In Cerebrovascular Inpatients: Example Of Rapidly Implementable Quality Improvement

Objective: To assess the effectiveness of an educational intervention in reducing utilization of low-value investigations in patients admitted with acute cerebrovascular disease. Background: the era of electronic ordering, thresholds for performing potentially low-value tests may be reduced. For high incidence disorders such as stroke, even low-cost tests can create considerable systemic costs if performed routinely. Methods: the pre-intervention phase, laboratory testing patterns were analyzed for patients admitted to the Mayo Clinic inpatient cerebrovascular service. review of the literature was performed, and two commonly performed laboratory studies (TSH and ESR) were targeted for In the intervention phase of the study, standardized weekly educational programs were presented to cerebrovascular service providers. Outcomes included ordering rates and standardized cost measures for TSH, ESR, and phlebotomies in consecutive patients following the intervention. Results: A total of 177 and 174 patients were included in the pre-intervention and intervention phases, respectively. The groups were similar in demographic and diagnostic composition. Mean length of stay (LOS) was shorter in the intervention group for ischemic stroke (p = 0.004) and hemorrhagic stroke (p = 0.02). Following intervention, the rate of TSH ordering was reduced by 41[percnt] (144/177 to 71/174, pu003c0.01) and ESR ordering was reduced by 50[percnt] (142/177 to 53/174, pu003c0.01). Corresponding costs were similarly reduced. Total phlebotomies per patient/day decreased from 1.14 to 0.97 (p=0.014) with a NNT of 6 to avoid one phlebotomy. Conclusions: this prospective quality improvement study, an educational intervention resulted in significant reduction in utilization of low-value tests in patients admitted to an inpatient cerebrovascular service. While the per-patient costs of these diagnostic tests were small, a similar approach at the system level could result in considerable avoidance of low value testing and associated costs, particularly if applied to higher-cost/lower-value investigations and procedures. Disclosure: Dr. Scharf has nothing to disclose. Dr. Jones has nothing to disclose. Dr. Martinez-Thompson has nothing to disclose. Dr. Pichler has nothing to disclose. Dr. Cohen has nothing to disclose. Dr. Clark has nothing to disclose. Dr. Nozile-Firth has nothing to disclose. Dr. Jones has nothing to disclose.