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Care initiative reduces unnecessary tests, spending

An initiative implemented in a hospital aimed at improving hospital care efficiency and decreasing costs has been successful in its first year, researchers reported in JAMA Internal Medicine.

Ronen Zalts, MD, and colleagues, inspired by the Choosing Wisely campaign, developed and instituted the initiative in 2014.

"A considerable proportion of hospital resources is spent on various laboratory and imaging tests," they wrote. "This reality presents a significant challenge to medical teams in regard to intelligent and efficient use of these tools during hospital care. The SMART (Specific, Measurable, Agreed, Required, and Timely) Medicine initiative, conducted by the Division of Internal Medicine at the Rambam Health Care Campus, aims to improve the efficiency of medical investigations by making the use of diagnostic tools more precise, focused and based on the clinical findings."

The researchers detailed the initiative as "a multifaceted medical education campaign managed by a group of senior physicians ... with continuous and systematic monitoring and feedback." The physicians met each month to discuss internal medicine practice issues with a content expert and Intel engineers to decide on a set of recommendations for laboratory tests for their colleagues and analyze corresponding data.

As detailed by the researchers, they released recommendations regarding the measurement of B-type natriuretic peptide levels in the workup for acute dyspnea and of troponin levels in the workup for acute chest pain. This resulted in reduced use of these tests (P < .001).

Additionally, they unbundled panel chemistry tests, which resulted in a more than 50% reduction of creatine kinase, amylase and lactic dehydrogenase level measurements.

Zalts and colleagues reported a 20% overall reduction in laboratory tests performed, which equated to $250,000 in savings, in the first year of implementation. They also noted a decrease in laboratory results turnaround time.

"In addition to cost-effectiveness, SMART Medicine has contributed to patient safety by avoiding unnecessary exposure to radiation, contrast media, incidental findings and false-positive results," Zalts and colleagues wrote. "In summary, SMART Medicine represents a milestone in the development and implementation of a defined method for wiser use of diagnostic tools." – by Chelsea Frajerman Pardes

Disclosure: The researchers report no relevant financial disclosures.