Think Twice: De-Implementation of Laboratory Testing After Colorectal Surgery
Clinically unindicated laboratory testing contributes to low-value care. Most postoperative day one labs after colorectal surgery are normal. However, no published interventions have shown reducing overall postoperative laboratory testing is safe. The aim of this study was to investigate the impact...
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Published in | Diseases of the colon & rectum Vol. 67; no. 4; pp. 587 - 595 |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
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United States
01.04.2024
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Abstract | Clinically unindicated laboratory testing contributes to low-value care. Most postoperative day one labs after colorectal surgery are normal. However, no published interventions have shown reducing overall postoperative laboratory testing is safe.
The aim of this study was to investigate the impact of reducing postoperative laboratory testing after colorectal surgery.
This is a quality improvement study.
The study was conducted at an academic center with an enhanced recovery after surgery program including 5 daily labs until discharge.
All adults undergoing colorectal or small bowel surgery formed intervention and non-intervention cohorts based on surgeons who chose to opt-into the study. Pre-implementation (November 2019 - October 2021) there were 545 intervention and 577 non-intervention patients. post-implementation (November 2021 - March 2023) there were 448 intervention and 437 non-intervention patients.
The intervention included 3 postoperative day one labs and subsequent clinically indicated labs.
Outcome measures included laboratory tests and lab-free days.
Post-intervention, the intervention group had a 33% reduction in labs per hospital stay, 26% reduction in labs per day, and 49% increase in lab-free days. There was no difference in length of stay (4 v 4; p = 0.79) or readmissions (14.9% v 12.9%; p = 0.39). The non-intervention group had no significant changes in lab work or lab-free days, with no differences in length of stay (4 v 4; p = 0.49) or readmissions (11.1% v 11.0%; p = 0.96).
Demographics and complication rate were not reported.
An intervention targeting reflexive laboratory testing after colorectal surgery resulted in safe, significant, sustained reductions in postoperative lab work, with substantial cost savings. These findings prompted a change in the laboratory order set to an opt-out system, and lab work reduction approaches have been implemented within other surgical divisions. Continuation and spread of these efforts are instrumental for prioritization of high-value surgical care. See Video Abstract at http://links.lww.com/DCR/Bxxx. |
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AbstractList | Clinically unindicated laboratory testing contributes to low-value care. Most postoperative day one labs after colorectal surgery are normal. However, no published interventions have shown reducing overall postoperative laboratory testing is safe.
The aim of this study was to investigate the impact of reducing postoperative laboratory testing after colorectal surgery.
This is a quality improvement study.
The study was conducted at an academic center with an enhanced recovery after surgery program including 5 daily labs until discharge.
All adults undergoing colorectal or small bowel surgery formed intervention and non-intervention cohorts based on surgeons who chose to opt-into the study. Pre-implementation (November 2019 - October 2021) there were 545 intervention and 577 non-intervention patients. post-implementation (November 2021 - March 2023) there were 448 intervention and 437 non-intervention patients.
The intervention included 3 postoperative day one labs and subsequent clinically indicated labs.
Outcome measures included laboratory tests and lab-free days.
Post-intervention, the intervention group had a 33% reduction in labs per hospital stay, 26% reduction in labs per day, and 49% increase in lab-free days. There was no difference in length of stay (4 v 4; p = 0.79) or readmissions (14.9% v 12.9%; p = 0.39). The non-intervention group had no significant changes in lab work or lab-free days, with no differences in length of stay (4 v 4; p = 0.49) or readmissions (11.1% v 11.0%; p = 0.96).
Demographics and complication rate were not reported.
An intervention targeting reflexive laboratory testing after colorectal surgery resulted in safe, significant, sustained reductions in postoperative lab work, with substantial cost savings. These findings prompted a change in the laboratory order set to an opt-out system, and lab work reduction approaches have been implemented within other surgical divisions. Continuation and spread of these efforts are instrumental for prioritization of high-value surgical care. See Video Abstract at http://links.lww.com/DCR/Bxxx. BACKGROUNDClinically unindicated laboratory testing contributes to low-value care. Most postoperative day 1 laboratory tests after colorectal surgery are normal. However, no published interventions have shown that reducing overall postoperative laboratory testing is safe.OBJECTIVEThis study aimed to investigate the impact of reducing postoperative laboratory testing after colorectal surgery.DESIGNThis is a quality improvement study.SETTINGSThe study was conducted at an academic center with an enhanced recovery after surgery program that included 5 daily laboratory tests until discharge.PATIENTSAll adults undergoing colorectal or small-bowel surgery formed intervention and nonintervention cohorts based on surgeons who chose to opt into the study. Preimplementation (November 2019-October 2021), there were 545 intervention and 577 nonintervention patients. Postimplementation (November 2021-March 2023), there were 448 intervention and 437 nonintervention patients.INTERVENTIONSThe intervention included 3 postoperative day 1 laboratory tests and subsequent clinically indicated laboratory tests.MAIN OUTCOME MEASURESOutcome measures included laboratory tests and days free of laboratory work.RESULTSPostintervention, the intervention group had a 33% reduction in laboratory tests per hospital stay, a 26% reduction in laboratory tests per day, and a 49% increase in laboratory test-free days. There was no difference in length of stay (4 vs 4; p = 0.79) or readmissions (14.9% vs 12.9%; p = 0.39). The nonintervention group had no significant changes in laboratory work or laboratory test-free days, with no differences in length of stay (4 vs 4; p = 0.49) or readmissions (11.1% vs 11.0%; p = 0.96).LIMITATIONSDemographics and complication rates were not reported.CONCLUSIONSAn intervention targeting reflexive laboratory testing after colorectal surgery resulted in safe, significant, sustained reductions in postoperative laboratory work, with substantial cost savings. These findings prompted a change in the laboratory order set to an opt-out system, and laboratory work reduction approaches have been implemented within other surgical divisions. Continuation and spread of these efforts are instrumental for prioritization of high-value surgical care. See Video Abstract .PINSELO DOS VECES ELIMINACIN DE LAS PRUEBAS DE LABORATORIO DESPUS DE LA CIRUGA COLORRECTALANTECEDENTES:Las pruebas de laboratorio clínicamente no indicadas contribuyen a una atención de bajo valor. La mayoría de los análisis de laboratorio del primer día post operatorios de una cirugía colorrectal son normales. Sin embargo, ninguna intervención publicada ha demostrado que reducir las pruebas de laboratorio post operatorias generales sea seguro.OBJETIVO:El objetivo de este estudio fue investigar el impacto de reducir las pruebas de laboratorio pos toperatorias después de la cirugía colorrectal.DISEÑO:Este es un estudio de mejora de la calidad.AJUSTES:El estudio se llevó a cabo en un centro académico con un programa mejorado de recuperación después de la cirugía que incluye 5 laboratorios diarios hasta el alta.PACIENTES:Todos los adultos sometidos a cirugía colorrectal o de intestino delgado formaron cohortes de intervención y no intervención basadas en los cirujanos que optaron por participar en el estudio. Antes de la implementación (noviembre de 2019 - octubre de 2021) había 545 pacientes con intervención y 577 sin intervención. Después de la implementación (noviembre de 2021 - marzo de 2023) hubo 448 pacientes con intervención y 437 sin intervención.INTERVENCIONES:La intervención incluyó 3 laboratorios post operatorios del primer día y laboratorios posteriores clínicamente indicados.PRINCIPALES MEDIDAS DE RESULTADO:Las medidas de resultado incluyeron pruebas de laboratorio y días sin laboratorio.RESULTADOS:Después de la intervención, el grupo de intervención tuvo una reducción del 33 % en laboratorios por estancia hospitalaria, una reducción del 26 % en laboratorios por día y un aumento del 49 % en los días sin laboratorio. No hubo diferencias en la duración de la estancia hospitalaria (4 frente a 4; p = 0,79) ni en los reingresos (14,9% frente a 12,9%; p = 0,39). El grupo de no intervención no tuvo cambios significativos en el trabajo de laboratorio o en los días sin laboratorio, sin diferencias en la duración de la estadía (4 versus 4; p = 0,49) o reingresos (11,1% versus 11,0%; p = 0,96).LIMITACIONES:No se informaron datos demográficos ni tasa de complicaciones.CONCLUSIONES:Una intervención dirigida a pruebas de laboratorio reflexivas después de la cirugía colorrectal resultó en reducciones seguras, significativas y sostenidas en el trabajo de laboratorio post operatorio, con ahorros sustanciales de costos. Estos hallazgos provocaron un cambio en el orden del laboratorio establecido hacia un sistema de exclusión voluntaria, y se han implementado enfoques de reducción del trabajo de laboratorio en otras divisiones quirúrgicas. La continuación y difusión de estos esfuerzos son fundamentales para priorizar la atención quirúrgica de alto valor. (Traducción-Dr. Mauricio Santamaria ). BACKGROUND: Clinically unindicated laboratory testing contributes to low-value care. Most postoperative day one labs after colorectal surgery are normal. However, no published interventions have shown reducing overall postoperative laboratory testing is safe. OBJECTIVE: The aim of this study was to investigate the impact of reducing postoperative laboratory testing after colorectal surgery. DESIGN: This is a quality improvement study. SETTINGS: The study was conducted at an academic center with an enhanced recovery after surgery program including 5 daily labs until discharge. PATIENTS: All adults undergoing colorectal or small bowel surgery formed intervention and non-intervention cohorts based on surgeons who chose to opt-into the study. Pre-implementation (November 2019 – October 2021) there were 545 intervention and 577 non-intervention patients. post-implementation (November 2021 – March 2023) there were 448 intervention and 437 non-intervention patients. INTERVENTIONS: The intervention included 3 postoperative day one labs and subsequent clinically indicated labs. MAIN OUTCOME MEASURES: Outcome measures included laboratory tests and lab-free days. RESULTS: Post-intervention, the intervention group had a 33% reduction in labs per hospital stay, 26% reduction in labs per day, and 49% increase in lab-free days. There was no difference in length of stay (4 v 4; p = 0.79) or readmissions (14.9% v 12.9%; p = 0.39). The non-intervention group had no significant changes in lab work or lab-free days, with no differences in length of stay (4 v 4; p = 0.49) or readmissions (11.1% v 11.0%; p = 0.96). LIMITATIONS: Demographics and complication rate were not reported. CONCLUSIONS: An intervention targeting reflexive laboratory testing after colorectal surgery resulted in safe, significant, sustained reductions in postoperative lab work, with substantial cost savings. These findings prompted a change in the laboratory order set to an opt-out system, and lab work reduction approaches have been implemented within other surgical divisions. Continuation and spread of these efforts are instrumental for prioritization of high-value surgical care. See Video Abstract at http://links.lww.com/DCR/Bxxx. |
Author | Dave, Yatee A Temple, Larissa Wakeman, Derek Cvetanovska, Marija Cannon, Lisa M Nabozny, Michael J Juviler, Peter |
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BackLink | https://www.ncbi.nlm.nih.gov/pubmed/38108409$$D View this record in MEDLINE/PubMed |
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