Audit-and-Feedback Utilizing Resident Consensus Standards Reduced Daily Labs

Abstract

<jats:title>ABSTRACT</jats:title> <jats:p>Background The Choosing Wisely campaign recommends that clinicians avoid repetitive laboratory testing in hospitalized patients who have clinical and laboratory stability; however, it is unclear how physicians define laboratory stability, or how they adhere to their own definition.</jats:p> <jats:p>Objective To quantify and compare what internal medicine residents and hospitalists consider a stable complete blood count (CBC) and chemistry panel, and to assess an audit-and-feedback intervention on residents, utilizing resident definitions of lab stability.</jats:p> <jats:p>Methods We used a 2-round consensus survey in 2023 to survey residents and hospitalists to determine consensus definitions of a stable CBC and chemistry panel. We then performed a 21-week audit-and-feedback intervention, providing residents weekly feedback of adherence to their cohort’s lab stability definitions. Percent of stable lab panels repeated was compared at baseline, during, and after the intervention.</jats:p> <jats:p>Results In our survey, residents (response rates 55 of 191, 29%; then 32 of 191, 17%) considered smaller day-to-day changes in complete blood count parameters as actionable compared to hospitalists (response rates 47 of 237, 20%; then 59 of 237, 25%). At baseline, residents repeated stable CBCs more often than hospitalists (1060 of 1566, 68% [95% CI, 65-70] vs 52 of 96, 54% [95% CI, 44-64], P=.005). During the intervention, residents repeated fewer stable CBCs (393 of 729, 54% [95% CI, 50-57], P&lt;.001) a reduction sustained at 6-months (635 of 1083, 59% [95% CI, 56-62], P&lt;.001).</jats:p> <jats:p>Conclusions Residents more frequently repeated CBCs that their cohort termed “stable” than did hospitalists. When residents were given feedback on adherence to their cohort’s lab stability criteria, there was a sustained reduction in the number of CBCs they ordered.</jats:p>