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Choosing Wisely Talks | Curbing Unnecessary Lab Testing: Understanding the National Landscape of Laboratory Utilization - Shared screen with speaker view
Jaana Ranchithan
Jaana Ranchithan
Please feel free to enter your questions or comments in the chat.
John Coppola
Any education provided around analytic and biologic variability with some of the commonly requested tests that then often leads to re-testing ++
Manuel Giraldo
Great presentation. Were you able to redirect the savings within your department?
Mike Kolber
Do you have a provincial reference that highlight ballpark (or actual) costs of commonly ordered tests in Nova Scotia that you share publically?
pouneh dokouhaki
Thank you for sharing your ideas and results in this excellent presentation. I was wondering what the composition of operational group that do all the utilization work is and how much total FTE is assigned for this (either clinical/MLT/ IT).
Karen Born
Thank you all for these excellent questions! There will be an open Q&A after Dr. Verma's presentation.
Tijn Kool
Very interesting. In the Netherlands, we are coordinating a comparable project in which now 20 hospitals are participating reducing lab diagnostics. We also focus on increasing awareness especially for residents because in the Netherlands, the residents order the most lab test. An important part is a transparent relation between supervising physician and resident. Was there also a special role for residents in your improvement project?
Charles Winegard
Could I see the slide again on intervals minimizing
Jaana Ranchithan
Hi Dr. Winegard - the recording for this webinar will be available on the Choosing Wisely Canada website later today.
Zahir Alshehry
Hi Dr. Amok, did you put into consideration the nature of work of each physician (e.g. ICU vs. ER vs. Dermatology)
Michael Mengel
Do you audit whether physicians actually look at their score card on a regular basis and if yes, that it changes their ordering behavior?
Arun Garg
Great Information, Dr Verma Can you share technical details of the program and efforts necessary to have a program in place. Thanks
Manuel Giraldo
Some of the tests are sent to rule out and may be negative or normal, but helps the physician to triage and manage the patient. For example Troponin
Manuel Giraldo
Agree with examples such as Protein Electrophoresis, ANA, etc
Zahir Alshehry
Hi Dr. Amok, did you put into consideration the nature of work of each physician (e.g. ICU vs. ER vs. Dermatology)
Zahir Alshehry
Hi Dr. Manual , Na, K, Cl, Co2 are all tested together at once either you request it or not which mean the cost of the panel is the same because it used the same method of measurement and reagent. So were is the value of saving in this regard?
Amol Verma
Zahir - Our work for now has just been with general medicine physicians and care on general medicine units. WE exclude care from other subspecialty areas, to make the comparisons more meaningful.
Sandip SenGupta
There are many data analytics middleware solutions on the market, but most are expensive. Can you give examples of HIS based middleware technologies that provide clinical decision support and data analytics, that can be readily retrieved by clinicians and administrators, in real time, rather than retrospective ad hoc data pulls?
Amol Verma
@Tijn - Great point. Residents in our teaching hospitals definitely influence test ordering heavily. About half of our hospitals are teaching and half non-teaching. We are linking resident training/staffing schedules to our data so we can start analyzing variation at the resident level and exploring opportunities to improve their education.
Sandip SenGupta
Reducing inappropriate referred out tests can have a dramatic effect on lab budgets. Can you provide some example of how you address high volume send out tests?
Manuel Giraldo
Hi, it would be great if you can get some commitment from SLT to redirect your savings within the lab department
Amol Verma
@Arun - absolutely. Email me at: amol.verma@mail.utoronto.ca
Amol Verma
@Michael - WE surveyed physicians. They spent on average 30 mins looking at their scorecard (they said), ranging from 1 min to 2 hours. 81% of physicians found something to improve based on their report and 95% said they wanted to continue receiving future reports.
Sandip SenGupta
What are the changes to CWC Hospital Designation that are related to the Choosing Labs Wisely initiative?
Manuel Giraldo
We were successful at NYGH with redirectingsavings to improve quality control/assurance practices and add new tests such NT proBNP
Charles Winegard
7 years ago at bluewater health in Sarnia we took the following tests off all order sets….TSH, AST, BUN, ESR, FOLATE, AMYLASE
Amol Verma
@Manuel - Totally agree, and I don't think the data can really give us a definitive answer on appropriateness, which is why context is so important. I think putting the data in front of clinicians to inform priority-setting is the best way forward.
Karen Born
@Sandip More details about these changes will come out in the fall and early 2022 on how Using Labs Wisely will be embedded within the CWC Hospital Designation. Thanks for this question!
Christine Collier
Any strategies for addressing repeat testing (MRI) for Trop or BNP by the presenters or participants? (inpatients may be different than outpatients)
Amol Verma
@sandip - Great point about middleware. I don't know of any good, cheap solutions, unfortunately! Maybe someone else in the CWC community on this webinar has some ideas?
Sandip SenGupta
Some US hospitals (e.g. Henry Ford, Michigan) use a “Lab Formulary”. Restriction similar to pharmacy. Any examples in Canada? I heard that PEI has one.
Christine Collier
Yes inpatients in particular
Zahir Alshehry
Can we get a record of answers in the chat to be included in the recorded video in your website? Thanks for great lecture from both presenter.
Jaana Ranchithan
@Zahir, the chat notes will be available and will included in the recording.
Ranae Smith
@sandip -Quest Diagnostics has a Physician Analytics / Lab Stewardship solution
Manal Elnenaei
Hi Tijin- great point and i totally agree with your point on residents driving testing for a number of reasons. We didn't have a special role for residents on these projects- but we may often engage with them when they contact us to ask about MRIs and refer out tests. But definitely an area that we need to work on. Thank you!
Ragnhild Nome
how do you recommend to start implementing such a project (using labs wisely) at a hospital?
Charles Winegard
Having some success with taking the repeat labs on day 1 or 2 after admissions off order sets
Sandip SenGupta
I’m looking at inviting patient advisors to my hospital’s Utilization Committee with respect to implementing CW requirements
Karen Born
thanks for sharing @Sandip
Karen Born
that's a great suggestion!
Sandip SenGupta
Patients have suggested posters, flyers, etc that could be posted throughout the hospital and in patient waiting rooms and examination rooms
Sandip SenGupta
This works particularly well for ambulatory care. We need to empower phlebotomists to reduce unnecessary inpatient pokes, just like Toyota Lean design where the worker on the assembly line can stop the process if he detects a problem
Jaana Ranchithan
Survey Link (English): https://www.surveymonkey.com/r/9NBQWW7Survey Link (French): https://fr.surveymonkey.com/r/9XF33M3
Arun Garg
The key issue in in patients is pre analytical and numbers, frequency of venipuncture, any streamlinking of reducing venipuncture is key for next steps
Jaana Ranchithan
If you have any questions following this presentation, please email us at info@choosingwiselycanada.org.
Rosemarie Volk
will the slides be available?
Manuel Giraldo
Thank you Karen! Great moderator.
Alisa Paneghel
Just wanted to say WOW, thank you to both the presenters and for the excellent, thought-provoking conversation here today! Great work (and clearly more to be done!) :)
Amol Verma
Thank you everyone!