Reducing Lab Tests to Prevent Hospital Infections

(RePORT-BC Trial)

Recruiting at 3 trial locations

Overseen By Anshula Ambasta

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of British Columbia

Disqualifiers: Specialized units, Critical care, Others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

700000 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether participants need to stop taking their current medications.

What data supports the effectiveness of the treatment Laboratory Test Overuse Intervention Bundle in reducing hospital infections?

Research shows that interventions aimed at reducing unnecessary lab tests in hospitals can lower the number of tests ordered without negatively affecting patient outcomes. For example, a study in long-term acute care hospitals found that tailored strategies to reduce lab test overuse led to fewer tests being ordered, which can help prevent potential harm and infections from unnecessary blood draws. ^{1 2 3 4 5}

Is the Laboratory Test Overuse (LTO) Bundle safe for humans?

The LTO Bundle aims to reduce unnecessary lab tests, which can lower the risk of infections and other complications from too many blood draws. Studies show that reducing lab test overuse does not negatively impact patient safety or outcomes. ^{1 2 3 5 6}

How is the LTO Bundle treatment different from other treatments for reducing lab test overuse?

The LTO Bundle is unique because it focuses on reducing unnecessary and repetitive laboratory tests in hospitals, which can help prevent infections and improve patient care. Unlike other treatments, it involves a systematic approach to change hospital staff behavior and awareness about lab test ordering, rather than relying on medication or direct patient interventions. ^{1 2 3 7 8}

What is the purpose of this trial?

The goal of this stepped-wedge cluster randomized trial is to assess the impact of a laboratory test overuse intervention bundle on laboratory test utilization in 6 health authorities (16 hospitals) in British Columbia. The main question it aims to answer is if the intervention bundle, inclusive of healthcare provider and patient engagement tools, can be effectively implemented for hospitalized medical inpatients in 16 hospitals across BC and reduce laboratory test over-use. Researchers will compare hospital clusters that receive the intervention at different (sequential) time points to see if there are significant changes in the measured outcomes after the intervention.

Research Team

Anshula Ambasta

Principal Investigator

University of British Columbia

Eligibility Criteria

This trial is for adult patients admitted under general internal medicine or family medicine in selected hospitals, as well as healthcare providers involved in their care. It includes physicians and allied health staff who can order labs. The study spans from May 2024 to October 2026.

Inclusion Criteria

Attending Physicians: All physicians providing patient care in the general internal medicine or family medicine (hospitalist) provider groups in selected hospitals

Learners and allied health staff: All individuals helping take care of patients and able to order labs during the study period in the general internal medicine or family medicine (hospitalist) provider groups in selected hospitals. Date range: May 2024 to October 2026

I am an adult admitted under general internal or family medicine.

Exclusion Criteria

I am a patient in a specialized medical unit such as coronary care or dialysis.

Patients and Health Care Providers (HCPs) not in the internal medicine or family medicine groups

Timeline

Control Period

Initial control period to collect baseline data before intervention

4 weeks

Pilot Phase

Feasibility assessment of intervention tools and adaptation to local context

4 weeks

Intervention Implementation

Sequential implementation of the intervention bundle in hospital clusters

8 weeks per cluster

Ongoing visits for implementation support

Post-Implementation Follow-up

Evaluation of the impact of intervention tools without dedicated personnel support

24 weeks

Treatment Details

Interventions

• Laboratory test overuse (LTO) Bundle

Trial Overview The trial tests a 'lab test overuse (LTO) Bundle' designed to reduce unnecessary lab tests in hospitals. It's a stepped-wedge cluster randomized trial across 16 BC hospitals, comparing the effect of this bundle on lab test use when implemented at different times.

Participant Groups

Group I: Intervention Arm (Intervention Bundle Implementation) Experimental Treatment 1 Intervention

This arm involves the time periods of the hospital units where the LTO bundle, including healthcare provider and patient engagement tools, is actively implemented.

Group II: Control Arm (No LTO Bundle Implementation) Active Control 1 Intervention

This arm represents the time period of hospital units where the LTO bundle is not implemented.

Who Is Running the Clinical Trial?

University of British Columbia

Lead Sponsor

Trials

1,506

Recruited

2,528,000+

Island Health

Collaborator

Trials

2

Recruited

700,000+

Northern Hospital, Australia

Collaborator

Trials

6

Recruited

702,000+

Canadian Institutes of Health Research (CIHR)

Collaborator

Trials

1,417

Recruited

26,550,000+

Providence Health & Services

Collaborator

Trials

131

Recruited

827,000+

Vancouver Coastal Health

Collaborator

Trials

41

Recruited

717,000+

Fraser Health

Collaborator

Trials

49

Recruited

708,000+

Interior Health

Industry Sponsor

Trials

7

Recruited

701,000+

Findings from Research

A multifaceted intervention bundle, including educational tools and peer discussions, led to a 14% reduction in routine laboratory tests ordered per patient-day among 125,854 patient-days studied, resulting in significant cost savings.

The intervention did not negatively impact patient safety, indicating that reducing unnecessary lab tests can be done safely without compromising care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Repurposing the Ordering of Routine Laboratory Tests in Hospitalised Medical Patients (RePORT): results of a cluster randomised stepped-wedge quality improvement study. Ambasta, A., Omodon, O., Herring, A., et al.[2023]

A review of 84 studies found that various interventions, including education and computerized provider order entry, can effectively reduce unnecessary laboratory testing in hospital settings, with nearly all studies reporting a decrease in test order volume.

However, the long-term sustainability of these interventions is uncertain, and only a few studies assessed their impact on patient-related clinical outcomes, highlighting the need for more rigorous, controlled trials to determine the most effective strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Reducing Test Utilization in Hospital Settings: A Narrative Review. Bindraban, RS., Ten Berg, MJ., Naaktgeboren, CA., et al.[2018]

A quality improvement initiative in long-term acute care hospitals successfully reduced unnecessary laboratory testing by an average of 0.37 lab tests per inpatient day, indicating improved lab utilization practices.

Importantly, this reduction in lab tests did not negatively affect patient safety or outcomes, as measures like ventilator weaning rates and infection rates remained stable.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Optimizing laboratory test utilization in long-term acute care hospitals. Mora, A., Krug, BS., Grigonis, AM., et al.[2020]

Implementing a mindfulness strategy on a 26-bed inpatient unit significantly reduced laboratory costs per patient from $117 to $66, resulting in an estimated total savings of $50,657 over 985 admissions.

The intervention led to a substantial decrease in the number of laboratory tests ordered, including complete blood counts and electrolyte panels, indicating a successful reduction in unnecessary testing.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Mindfulness-Based Laboratory Reduction: Reducing Utilization Through Trainee-Led Daily 'Time Outs'. McDonald, EG., Saleh, RR., Lee, TC.[2022]

Physicians often misuse clinical laboratory tests by either ordering too many unnecessary tests or not enough, leading to overutilization, especially in searching for asymptomatic diseases and frequent monitoring.

To combat overutilization, various strategies can be implemented, including educational programs for physicians, audits with feedback, and administrative protocols to standardize test ordering practices.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Utilization review and management of laboratory testing in the ambulatory setting. Statland, BE., Winkel, P.[2019]

A multilevel laboratory stewardship intervention successfully reduced unnecessary laboratory tests by 1.5 to 2 tests per patient-day in thoracic and cardiac surgery services, totaling an estimated 20,000 fewer tests during the intervention period.

The intervention did not negatively affect patient outcomes, such as length of stay, readmissions, or mortality, indicating that reducing lab tests can improve efficiency without compromising patient safety.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of a Multilevel Laboratory Stewardship Intervention Targeted to Cardiac and Thoracic Surgical Services at an Academic Medical Center. Mathias, PC., Khor, S., Harris, K., et al.[2023]

The Hard Stop clinical decision support tool, which requires justification for duplicate lab tests, was significantly more effective in preventing unnecessary testing (92.3% effectiveness) compared to the Smart Alert tool (42.6% effectiveness).

Implementing the Hard Stop resulted in greater cost savings, averaging $16.08 per alert activated, compared to only $3.52 per alert for the Smart Alert, highlighting the financial benefits of requiring justification for duplicate tests.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Reducing duplicate testing: a comparison of two clinical decision support tools. Procop, GW., Keating, C., Stagno, P., et al.[2022]

A study of 106,813 general internal medicine hospitalizations identified 21 laboratory tests that collectively cost over $15,400, highlighting significant opportunities to reduce unnecessary testing.

The analysis revealed that tests like lactate and antiphospholipid antibodies had high costs, low abnormal result rates, and significant variation in physician use, indicating they are prime candidates for interventions to minimize overuse.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Data-driven approach to identifying potential laboratory overuse in general internal medicine (GIM) inpatients. Weinerman, AS., Guo, Y., Saha, S., et al.[2023]

References

1. England pubmed.ncbi.nlm.nih.gov

Repurposing the Ordering of Routine Laboratory Tests in Hospitalised Medical Patients (RePORT): results of a cluster randomised stepped-wedge quality improvement study. [2023]

2. Korea (South) pubmed.ncbi.nlm.nih.gov

Reducing Test Utilization in Hospital Settings: A Narrative Review. [2018]

3. United States pubmed.ncbi.nlm.nih.gov

Optimizing laboratory test utilization in long-term acute care hospitals. [2020]

4. United States pubmed.ncbi.nlm.nih.gov

Mindfulness-Based Laboratory Reduction: Reducing Utilization Through Trainee-Led Daily 'Time Outs'. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Utilization review and management of laboratory testing in the ambulatory setting. [2019]

6. United States pubmed.ncbi.nlm.nih.gov

Evaluation of a Multilevel Laboratory Stewardship Intervention Targeted to Cardiac and Thoracic Surgical Services at an Academic Medical Center. [2023]

7. England pubmed.ncbi.nlm.nih.gov

Reducing duplicate testing: a comparison of two clinical decision support tools. [2022]

8. England pubmed.ncbi.nlm.nih.gov

Data-driven approach to identifying potential laboratory overuse in general internal medicine (GIM) inpatients. [2023]