1. Better Utilization of Lab Testing to Reduce Medical Costs; A Quality Improvement Project to Reduce BMP and CBC Utilization Among Medical Residents at Mount Carmel West
Noah Hagen D.O., Carter Battista D.O., Stacie Hirota D.O., Olamide Johnson D.O., Marie-Josée Pagé D.O., Jason Son D.O., Adam Thomas D.O., David Aufdencamp M.B.A., Robert Battisti M.D.

2. Introduction
As part of the ABIM Choosing Wisely initiative, the Society of Hospital Medicine has emphasized repetitive complete blood count (CBC) and basic metabolic panel (BMP) testing among its top five practices that physicians and patients should question1.
Reduction of unnecessary laboratory testing is important not only for cost containment, but also for improved patient experience and avoidance of iatrogenic harm2,3,4.

3. How much do you think obtaining daily CBC and BMP costs per day?

4. Has ordering daily BMP and CBC become automatic?

5. What percentage of patients do you think you get daily BMPs and CBCs on?

6. Introduction
Mount Carmel West direct line charge of a CBC was $36 and BMP was $405.
QI Project focusing on educational interventions including cost education and appropriate utilization with specific achievable goals.

7. Quality Improvement Goal
Our internal medicine residency program is seeking to reduce unnecessary ordering of daily CBCs and BMPs on the general medicine floors. Our goal is to reduce orders for CBC/patient/day and BMP/patient/day each by 20%.

8. Interventions
Education and feedback tailored for internal medicine residents.
Including:
Lectures
Monthly faculty reminders
updates
Lab cost badge displays
Residents were encouraged to evaluate each patient daily for the need for daily CBC and BMP.
What will you change as a result of this test?
Educational

9. Data Methods
CBC and BMP orders per patient/per day on General Med/Surg floors order by IM residents
Data from ICU excluded
Pre-intervention data from 09/2015 to 12/2015
Post-intervention data from 09/2016 to 12/2016 in number of
Pre-and post-intervention compared using two-sample Poisson rate test for statistical significance
Overall
By Month run for further future directions on intervention timing

10. Results Pre-Intervention (2015) Post- Intervention (2016)
1.18 BMP/patient/day
1.19 CBC/patient/day
Post- Intervention (2016)
0.92 BMP/patient/day
22.1% reduction (p < 0.001)
1.06 CBC/patient/day
10.7% reduction (p = 0.014).

11. Results

12. Impact Less patient harm
IM Residency average daily floor census: patients/day
Reduction of 2,722 BMPs/ year and 1,607 CBCs/year
$186,500 per calendar year in direct testing costs

13. Conclusion Target 20% reduction of CBC/patient/day and BMP/patient/day
Reduced BMP/patient/day by 22.1%, and CBC/patient/day by 10.7%.
Achieved with only educational lectures and monthly updates.

14. Conclusion Only took 16 to 20 person-hours
Small cost to make lab cost badge displays.
With more time and further education, we believe our goal reduction in CBC/BMP ordering can be reached, expanded, and more specifically targeted.

15. References
John Bulger DO, MBA,Wendy Nickel MPH,Jordan Messler MD,Jenna Goldstein MA, James O'Callaghan MD, Moises Auron MD,Mangla Gulati MD Choosing wisely in adult hospital medicine: Five opportunities for improved healthcare value Journal of Hospital Medicine, 19 August 2013 
Salisbury AC, Reid KJ, Alexander KP, Masoudi FA, Lai SM, Chan PS, Bach RG, Wang TY, Spertus JA, Kosiborod M. Diagnostic blood loss from phlebotomy and hospital-acquired anemia during Acute Myocardial Infarction. Arch Intern Med Oct 10 ;171(18):  
Thavendiranathan P, Bagai A, Ebidia A, Detsky AS, Choudhry NK. Do blood tests cause anemia in hospitalized patients?: The effect of diagnostic phlebotomy on hemoglobin and hematocrit levels. J Gen Intern Med June;20(6):520–524. 
Stuebing EA, Miner TJ. Surgical vampires and rising health care expenditure: reducing the cost of daily phlebotomy. Arch Surg May;146(5):524-7.
Mount Carmel West Charge Database

16. Growing into next year!