Re-Purposing the Ordering of 'Routine' Laboratory Tests in Hospitalized Medical Patients (RePORT Study)
- Conditions
- Utilization, Health Care
- Registration Number
- NCT06119464
- Lead Sponsor
- University of Calgary
- Brief Summary
Laboratory test overuse occurs when tests are ordered repetitively, without due consideration of impact on clinical status. Repetitive inpatient lab testing often provides limited value for patient outcomes while increasing healthcare costs, patient discomfort, and unnecessary transfusions and prolonging hospitalizations. The research study aims to reduce laboratory test overuse in hospitals through implementation of a comprehensive, multi-disciplinary, and multi-faceted intervention bundle that includes audit and feedback reports, clinician education, clinical decision support tool, and patient infographics across 14 hospitals in Alberta.
- Detailed Description
Background: Laboratory and Pathology testing contributes to rising health care expenditure. A relatively large percentage (up to 42%) of laboratory testing can be considered wasteful. Redundant testing alone has been estimated to waste up to 5 billion dollars annually in the United States of America. Laboratory over-utilization leads to false positives that promotes further inappropriate testing and procedures, interruption of normal sleep pattern of inpatients, as well as iatrogenic anemia and pain. A Canadian study showed significant hemoglobin reductions as a result of phlebotomy. Studies support the safe reduction of repetitive laboratory testing without negative effects on adverse events, readmission rates, critical care utilization, or mortality.
The aim of this research study is the following:
1. To implement a multimodal intervention bundle containing healthcare provider and patient engagement tools for hospitalized medical inpatients in 14 hospitals across the province of Alberta in Canada using a cluster randomized stepped-wedge design
2. To evaluate the impact of the intervention bundle on laboratory test utilization of six target laboratory tests (complete blood count, electrolytes, creatinine, urea, partial thromboplastin time, and international normalized ratio), costs, and patient safety outcomes.
This intervention bundle will be implemented across all the adult hospital sites in Alberta starting January 2023 and evaluated until October 2024.
Recruitment & Eligibility
- Status
- ACTIVE_NOT_RECRUITING
- Sex
- All
- Target Recruitment
- 251817
- all participants (patients and healthcare providers) within enrolled adult hospitals in Alberta of medical and hospitalist units during study period
- outside of the above-mentioned province
- hospitals not enrolled
- non-medical units (eg. ICU, surgical, pediatric, obstetrical units)
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- CROSSOVER
- Primary Outcome Measures
Name Time Method Number of routine laboratory tests ordered per patient-day in the intervention versus control periods 1 year 9 months Number of the six target laboratory tests (complete blood count, electrolytes, creatinine, urea, international normalized ratio and partial thromboplastin time) ordered per patient-day
- Secondary Outcome Measures
Name Time Method 30-day post discharge readmission rate 30 days post discharge Hospital re-admission within 30 days post discharge
Length of stay 1 year 9 months Patient length of stay on the unit
In-patient and 30-day patient mortality over study period 30 days post discharge Mortality rate in hospital and at 30-days post discharge
Proportion of critically abnormal test results 1 year 9 months As defined by lab standards, we will track the proportion of critically abnormal test results
Transfer to Intensive Care Unit 1 year 9 months Transfer rate to Intensive Care Unit
Costs associated with routine and all common laboratory test ordered 1 year 9 months Costs of test and associated costs with and without intervention
Proportion of hospital patient lab-free days 1 year 9 months Number of hospital patient-days not associated with laboratory blood draws
Number of all common laboratory tests 1 year 9 months Number of all common laboratory tests (tests that contribute to \>80% of hospital laboratory test utilization during study period) per patient-day.
Trial Locations
- Locations (1)
University of Calgary
🇨🇦Calgary, Alberta, Canada