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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if a special set of tools can reduce unnecessary lab tests in hospitals, thereby lowering infection risks. The trial uses an "LTO Bundle" (Laboratory Test Overuse Bundle), a collection of strategies designed to engage patients and healthcare workers in smarter test usage. Different hospitals will implement this bundle at various times to assess its effectiveness. The trial is best suited for adult patients admitted to general medical units and healthcare providers, such as doctors and nurses, working in those areas. As an unphased trial, it provides a unique opportunity for patients to contribute to improving hospital practices and patient safety.

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 prior data suggests that this intervention bundle is safe for hospitalized medical inpatients?

Research has shown that the Laboratory Test Overuse (LTO) Bundle addresses the issue of unnecessary lab tests in hospitals. This bundle includes tools to engage both healthcare providers and patients. Studies have found that reducing unnecessary lab tests can save money and increase patient comfort.

While specific data on the safety of the LTO Bundle itself is not available, it focuses on changing hospital practices rather than introducing new drugs or devices. This approach poses little to no risk of physical harm to patients. The goal is to enhance decision-making about lab tests, which should be easy to accept since it doesn't involve new medical treatments. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the trial for the LTO Bundle because it targets the overuse of lab tests, which can contribute to hospital-acquired infections. Unlike standard practices that don't actively address this, the LTO Bundle focuses on changing healthcare provider behavior and engaging patients to reduce unnecessary tests. This proactive approach aims to enhance patient safety and potentially reduce infection rates by minimizing exposure to hospital environments and invasive procedures.

What evidence suggests that the Laboratory Test Overuse (LTO) Bundle is effective in reducing lab test overuse?

Research has shown that reducing unnecessary lab tests can lower the risk of hospital infections. Studies have found that when hospitals cut excessive lab tests, patients experience fewer complications and better outcomes. This trial tests the Laboratory Test Overuse (LTO) Bundle as an intervention to encourage healthcare providers to reconsider ordering potentially unnecessary lab tests. This approach not only enhances patient safety but also reduces healthcare costs. Early evidence suggests that using these intervention bundles in hospitals can lead to more efficient care and decrease the risks associated with over-testing. Participants in the intervention arm will experience the implementation of the LTO Bundle, while those in the control arm will not. ^{1 6}

Who Is on the Research Team?

Anshula Ambasta

Principal Investigator

University of British Columbia

Are You a Good Fit for This Trial?

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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 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]

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]

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]

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]

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]

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 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]

Citations

1. withpower.com withpower.com/trial/phase-iatrogenic-disease-4-2024-b26eb

Reducing Lab Tests to Prevent Hospital Infections The goal of this stepped-wedge cluster randomized trial is to assess the impact of a laboratory test overuse intervention bundle on laboratory test ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11221016/

Re-Purposing the Ordering of Routine Laboratory Tests in ... Laboratory test overuse in hospitals is a form of healthcare waste that also harms patients. Developing and evaluating interventions to reduce ...

3. sciencedirect.com sciencedirect.com/science/article/pii/S0196655323001128

Empowering patients to prevent healthcare-associated ... Empowering patients to reduce overuse of devices. Medical devices such as indwelling urinary catheters and central venous catheters are overused and frequently ...

4. bmcinfectdis.biomedcentral.com bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-025-11210-z

A prospective cluster randomized trial of an interventions ... Overuse and misuse of antibiotics in humans and animals is a global problem and a leading cause of increasing antimicrobial resistance. The ...

5. researchgate.net researchgate.net/publication/334664373_Association_of_a_Multifaceted_Intervention_With_Ordering_of_Unnecessary_Laboratory_Tests_Among_Caregivers_in_Internal_Medicine_Departments

Association of a Multifaceted Intervention With Ordering ... reducing unnecessary laboratory testing. 6-8. In addition to financial consequences, overuse is less ... Background: To reduce overutilization of laboratory ...

6. withpower.com withpower.com/trial/phase-utilization-health-care-2023-acf39

Multimodal Lab Test Strategy for Health Care Utilization What is the purpose of this trial? Laboratory test overuse occurs when tests are ordered repetitively, without due consideration of impact on clinical status.