TY - JOUR
T1 - Targeted reduction in neurosurgical laboratory utilization
T2 - Resident-led effort at a single academic institution. Clinical article
AU - Han, Seunggu J.
AU - Saigal, Rajiv
AU - Rolston, John D.
AU - Cheng, Jason S.
AU - Lau, Catherine Y.
AU - Mistry, Rita I.
AU - Mcdermott, Michael W.
AU - Berger, Mitchel S.
N1 - Copyright:
Copyright 2014 Elsevier B.V., All rights reserved.
PY - 2014/1
Y1 - 2014/1
N2 - Object. Given economic limitations and burgeoning health care costs, there is a need to minimize unnecessary diagnostic laboratory tests. Methods. The authors studied whether a financial incentive program for trainees could lead to fewer unnecessary laboratory tests in neurosurgical patients in a large, 600-bed academic hospital setting. The authors identified 5 laboratory tests that ranked in the top 13 of the most frequently ordered during the 2010-2011 fiscal year, yet were least likely to be abnormal or influence patient management. Results. In a single year of study, there was a 47% reduction in testing of serum total calcium, ionized calcium, chloride, magnesium, and phosphorus. This reduction led to a savings of $1.7 million in billable charges to health care payers and $75,000 of direct costs to the medical center. In addition, there were no significant negative changes in the quality of care delivered, as recorded in a number of metrics, showing that this cost savings did not negatively impact patient care. Conclusions. Engaging physician trainees in quality improvement can be successfully achieved by financial incentives. Through the resident-led quality improvement incentive program, neurosurgical trainees successfully reduced unnecessary laboratory tests, resulting in significant cost savings to both the medical center and the health care system. Similar programs that engage trainees could improve the value of care being provided at other academic medical centers.
AB - Object. Given economic limitations and burgeoning health care costs, there is a need to minimize unnecessary diagnostic laboratory tests. Methods. The authors studied whether a financial incentive program for trainees could lead to fewer unnecessary laboratory tests in neurosurgical patients in a large, 600-bed academic hospital setting. The authors identified 5 laboratory tests that ranked in the top 13 of the most frequently ordered during the 2010-2011 fiscal year, yet were least likely to be abnormal or influence patient management. Results. In a single year of study, there was a 47% reduction in testing of serum total calcium, ionized calcium, chloride, magnesium, and phosphorus. This reduction led to a savings of $1.7 million in billable charges to health care payers and $75,000 of direct costs to the medical center. In addition, there were no significant negative changes in the quality of care delivered, as recorded in a number of metrics, showing that this cost savings did not negatively impact patient care. Conclusions. Engaging physician trainees in quality improvement can be successfully achieved by financial incentives. Through the resident-led quality improvement incentive program, neurosurgical trainees successfully reduced unnecessary laboratory tests, resulting in significant cost savings to both the medical center and the health care system. Similar programs that engage trainees could improve the value of care being provided at other academic medical centers.
KW - Cost reduction
KW - Quality improvement
KW - Resident education
KW - Value-based care
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U2 - 10.3171/2013.8.JNS13512
DO - 10.3171/2013.8.JNS13512
M3 - Article
C2 - 24125592
AN - SCOPUS:84889245035
SN - 0022-3085
VL - 120
SP - 173
EP - 177
JO - Journal of neurosurgery
JF - Journal of neurosurgery
IS - 1
ER -