Reducing Test Utilization in Hospital Settings: A Narrative Review.
Ontology highlight
ABSTRACT: Studies addressing the appropriateness of laboratory testing have revealed approximately 20% overutilization. We conducted a narrative review to (1) describe current interventions aimed at reducing unnecessary laboratory testing, specifically in hospital settings, and (2) provide estimates of their efficacy in reducing test order volume and improving patient-related clinical outcomes.The PubMed, Embase, Scopus, Web of Science, and Canadian Agency for Drugs and Technologies in Health-Health Technology Assessment databases were searched for studies describing the effects of interventions aimed at reducing unnecessary laboratory tests. Data on test order volume and clinical outcomes were extracted by one reviewer, while uncertainties were discussed with two other reviewers. Because of the heterogeneity of interventions and outcomes, no meta-analysis was performed.Eighty-four studies were included. Interventions were categorized into educational, (computerized) provider order entry [(C)POE], audit and feedback, or other interventions. Nearly all studies reported a reduction in test order volume. Only 15 assessed sustainability up to two years. Patient-related clinical outcomes were reported in 45 studies, two of which found negative effects.Interventions from all categories have the potential to reduce unnecessary laboratory testing, although long-term sustainability is questionable. Owing to the heterogeneity of the interventions studied, it is difficult to conclude which approach was most successful, and for which tests. Most studies had methodological limitations, such as the absence of a control arm. Therefore, well-designed, controlled trials using clearly described interventions and relevant clinical outcomes are needed.
<h4>Background</h4>Studies addressing the appropriateness of laboratory testing have revealed approximately 20% overutilization. We conducted a narrative review to (1) describe current interventions aimed at reducing unnecessary laboratory testing, specifically in hospital settings, and (2) provide estimates of their efficacy in reducing test order volume and improving patient-related clinical outcomes.<h4>Methods</h4>The PubMed, Embase, Scopus, Web of Science, and Canadian Agency for Drugs and ...[more]
Project description:ObjectivesThis narrative review aimed to explore the impact of checklists and error reporting systems on hospital patient safety and medical errors.MethodsA systematic search of academic databases from 2013 to 2023 was conducted, and peer-reviewed studies meeting inclusion criteria were assessed for methodological rigor. The review highlights evidence supporting the efficacy of checklists in reducing medication errors, surgical complications, and other adverse events. Error reporting systems foster transparency, encouraging professionals to report incidents and identify systemic vulnerabilities.ResultsChecklists and error reporting systems are interconnected. Interprofessional collaboration is emphasized in checklist implementation. In this review, limitations arise due to the different methodologies used in the articles and potential publication bias. In addition, language restrictions may exclude valuable non-English research. While positive impacts are evident, success depends on organizational culture and resources.ConclusionsThis review contributes to patient safety knowledge by examining the relevant literature, emphasizing the importance of interventions, and calling for further research into their effectiveness across diverse healthcare and cultural settings. Understanding these dynamics is crucial for healthcare providers to optimize patient safety outcomes.
Project description:Sepsis, the most expensive cause of hospitalization in the United States, is associated with high morbidity and mortality. However, healthcare utilization patterns following sepsis are poorly understood.To identify patient-level factors that contribute to postsepsis mortality and healthcare utilization.A retrospective study of sepsis patients drawn from 21 community-based hospitals in Kaiser Permanente Northern California in 2010.We determined 1-year survival and use of outpatient and facility-based healthcare before and after sepsis and used logistic regression to identify the factors that contributed to early readmission (within 30 days) and high utilization (? 15% of living days spent in facility-based care).Among 6344 sepsis patients, 5479 (86.4%) survived to hospital discharge. Mean age was 72 years with 28.9% of patients aged <65 years. Postsepsis survival was strongly modified by age; 1-year survival was 94.1% for <45 year olds and 54.4% for ? 85 year olds. A total of 978 (17.9%) patients were readmitted within 30 days; only a minority of all rehospitalizations were for infection. After sepsis, adjusted healthcare utilization increased nearly 3-fold compared with presepsis levels and was strongly modified by age. Patient factors including acute severity of illness, hospital length of stay, and the need for intensive care were associated with early readmission and high healthcare utilization; however, the dominant factors explaining variability-comorbid disease burden and high presepsis utilization-were present prior to sepsis admission.Postsepsis survival and healthcare utilization were most strongly influenced by patient factors already present prior to sepsis hospitalization.
Project description:(1) Background: The evidence to support transitional care in reducing acute hospital utilization is variable. Despite changes in the healthcare landscape with a rapidly aging population, there is a lack of local and regional studies to evaluate the effectiveness of transitional home care programs. This study investigates whether a transitional home care program delivered by an acute tertiary hospital can reduce acute hospital utilization. (2) Methods: A pre-post design was used to evaluate the effectiveness of the program. A total of 2004 enrolments from 1679 unique patients that fulfilled the criteria of enrolment were included. The transitional care program is delivered through telephone follow-up and home visits. The Wilcoxon Signed-Rank Test was used to assess the differences between the three periods of baseline, enrolment, and post-enrolment. (3) Results: All 2004 enrolments were analyzed. The re-attendances at the emergency department reduced significantly by 31.2% and 71.9% during enrolment and post-enrolment (p < 0.001), respectively. Similarly, patients had a 38.7% and 76.2% reduction in hospital admissions during enrolment and post-enrolment (p < 0.001), respectively. For patients who were admitted, there was no significant difference in the length of stay between these groups (p = 0.23). (4) Conclusions: The transitional home care program can effectively reduce emergency department re-attendances and inpatient admissions. Not only was the total number of emergency department re-attendances reduced significantly, but the number of frequent re-attendances also dropped significantly. The outcomes were consistent during COVID-19 and post-pandemic phases. These findings can be used as a guide in program planning and future scalability.
Project description:BACKGROUND: The geriatric nursing home population is vulnerable to acute and deteriorating illness due to advanced age, multiple chronic illnesses and high levels of dependency. Although the detriments of hospitalising the frail and old are widely recognised, hospital admissions from nursing homes remain common. Little is known about what alternatives exist to prevent and reduce hospital admissions from this setting. The objective of this study, therefore, is to summarise the effects of interventions to reduce acute hospitalisations from nursing homes. METHODS: A systematic literature search was performed in Cochrane Library, PubMed, MEDLINE, EMBASE and ISI Web of Science in April 2013. Studies were eligible if they had a geriatric nursing home study population and were evaluating any type of intervention aiming at reducing acute hospital admission. Systematic reviews, randomised controlled trials, quasi randomised controlled trials, controlled before-after studies and interrupted time series were eligible study designs. The process of selecting studies, assessing them, extracting data and grading the total evidence was done by two researchers individually, with any disagreement solved by a third. We made use of meta-analyses from included systematic reviews, the remaining synthesis is descriptive. Based on the type of intervention, the included studies were categorised in: 1) Interventions to structure and standardise clinical practice, 2) Geriatric specialist services and 3) Influenza vaccination. RESULTS: Five systematic reviews and five primary studies were included, evaluating a total of 11 different interventions. Fewer hospital admissions were found in four out of seven evaluations of structuring and standardising clinical practice; in both evaluations of geriatric specialist services, and in influenza vaccination of residents. The quality of the evidence for all comparisons was of low or very low quality, using the GRADE approach. CONCLUSIONS: Overall, eleven interventions to reduce hospital admissions from nursing homes were identified. None of them were tested more than once and the quality of the evidence was low for every comparison. Still, several interventions had effects on reducing hospital admissions and may represent important aspects of nursing home care to reduce hospital admissions.
Project description:BackgroundTrustful relationships play a vital role in successful organisations and well-functioning hospitals. While the trust relationship between patients and providers has been widely studied, trust relations between healthcare professionals and their supervisors have not been emphasised. A systematic literature review was conducted to map and provide an overview of the characteristics of trustworthy management in a hospital setting.MethodsWe searched Web of Science, Embase, MEDLINE, APA PsycInfo, CINAHL, Scopus, EconLit, Taylor & Francis Online, SAGE Journals and Springer Link from database inception up until Aug 9, 2021. Empirical studies written in English undertaken in a hospital or similar setting and addressed trust relationships between healthcare professionals and their supervisors were included, without date restrictions. Records were independently screened for eligibility by two researchers. One researcher extracted the data and another one checked the correctness. A narrative approach, which involves textual and tabular summaries of findings, was undertaken in synthesising and analysing the data. Risk of bias was assessed independently by two researchers using two critical appraisal tools. Most of the included studies were assessed as acceptable, with some associated risk of bias.ResultsOf 7414 records identified, 18 were included. 12 were quantitative papers and 6 were qualitative. The findings were conceptualised in two categories that were associated with trust in management, namely leadership behaviours and organisational factors. Most studies (n = 15) explored the former, while the rest (n = 3) additionally explored the latter. Leadership behaviours most commonly associated with employee's trust in their supervisors include (a) different facets of ethical leadership, such as integrity, moral leadership and fairness; (b) caring for employee's well-being conceptualised as benevolence, supportiveness and showing concern and (c) the manager's availability measured as being accessible and approachable. Additionally, four studies found that leaders' competence were related to perceptions of trust. Empowering work environments were most commonly associated with trust in management.ConclusionsEthical leadership, caring for employees' well-being, manager's availability, competence and an empowering work environment are characteristics associated with trustworthy management. Future research could explore the interplay between leadership behaviours and organisational factors in eliciting trust in management.
Project description:BackgroundEnsuring accurate and continuous monitoring of patients' physiological parameters is paramount for evaluating their health status and guiding clinical decision-making. Technological advancements have the potential to significantly improve patient care and outcomes by offering a seamless continuum of healthcare experiences. Biobeat Technologies Ltd has pioneered a non-invasive wearable approach to acquiring advanced hemodynamic parameters, employing devices such as the BB-613WP wrist monitor and the BB-613P chest patch. Biobeat devices have been applicable across many clinical settings, as substantiated by a growing body of research. This systematic review endeavours to comprehensively consolidate the evidence regarding using Biobeat monitors across various clinical scenarios.MethodsFrom 2016 to 2024, a thorough literature search was conducted across multiple databases. The inclusion criteria for selected studies comprised adult patients aged 18 years or older in any healthcare setting, employing Biobeat monitoring devices (wrist monitors and/or chest patches), reporting at least one outcome or finding, and presenting fully published original research studies, including randomized controlled trials and prospective or retrospective cohort studies. The quality and risk of bias assessment for the studies was performed using the Newcastle-Ottawa scale and COSMIN scoring system.ResultsAmong 27 studies identified, 15 met the inclusion criteria, involving 4248 patients. These included 14 prospective observational studies and one retrospective cohort study; no randomized control trials were identified. Notably, eight studies were conducted in ambulatory settings, with 1 study focusing on patients undergoing labor and delivery. Additionally, three studies were carried out in general inpatient wards, 1 in a medical ICU and another in a cardiac surgery ICU (CSICU). Furthermore, 1 study presented results from 3 separate investigations- 2 in ambulatory settings and 1 in the CSICU. Across all studies, Biobeat devices were consistently utilized, with each study reporting positive outcomes associated with their use.ConclusionThis systematic review demonstrates that Biobeat's non-invasive wearable devices have been effectively utilized across various clinical settings, consistently contributing to positive patient outcomes. The versatility and reliability of these devices highlight their potential to enhance patient care and support clinical decision-making, warranting further research to explore their broader applications.
Project description:BackgroundAgeing into adulthood is challenging at baseline, and doing so with a chronic disease can add increased stress and vulnerability. Worldwide, a substantial care gap exists as children transition from care in a paediatric to adult setting. There is no current consensus on safe and equitable healthcare transition (HCT) for patients with chronic disease in resource-denied settings. Much of the existing literature is specific to HIV care. The objective of this narrative review was to summarise current literature related to adolescent HCT not associated with HIV, in low-income and middle-income countries (LMICs) and other resource-denied settings, in order to inform equitable health policy strategies.MethodsA literature search was performed using defined search terms in PubMed and Cumulative Index to Nursing and Allied Health Literature databases to identify all peer-reviewed studies published until January 2020, pertaining to paediatric to adult HCT for adolescents and young adults with chronic disease in resource-denied settings. Following deduplication, 1111 studies were screened and reviewed by two independent reviewers, of which 10 studies met the inclusion criteria. Resulting studies were included in thematic analysis and narrative synthesis.ResultsTwelve subthemes emerged, leading to recommendations which support equitable and age-appropriate adolescent care. Recommendations include (1) improvement of community health education and resilience tools for puberty, reproductive health and mental health comorbidities; (2) strengthening of health systems to create individualised adolescent-responsive policy; (3) incorporation of social and financial resources in the healthcare setting; and (4) formalisation of institution-wide procedures to address community-identified barriers to successful transition.ConclusionLimitations of existing evidence relate to the paucity of formal policy for paediatric to adult transition in LMICs for patients with childhood-onset conditions, in the absence of a diagnosis of HIV. With a rise in successful treatments for paediatric-onset chronic disease, adolescent health and transition programmes are needed to guide effective health policy and risk reduction for adolescents in resource-denied settings.
Project description:Safeguarding vulnerable patients is a key responsibility of healthcare professionals. Yet, existing clinical and patient management protocols are outdated as they do not address the emerging threats of technology-facilitated abuse. The latter describes the misuse of digital systems such as smartphones or other Internet-connected devices to monitor, control and intimidate individuals. The lack of attention given to how technology-facilitated abuse may affect patients in their lives, can result in clinicians failing to protect vulnerable patients and may affect their care in several unexpected ways. We attempt to address this gap by evaluating the literature that is available to healthcare practitioners working with patients impacted by digitally enabled forms of harm. A literature search was carried out between September 2021 and January 2022, in which three academic databases were probed using strings of relevant search terms, returning a total of 59 articles for full text review. The articles were appraised according to three criteria: (a) the focus on technology-facilitated abuse; (b) the relevance to clinical settings; and (c) the role of healthcare practitioners in safeguarding. Of the 59 articles, 17 articles met at least one criterion and only one article met all three criteria. We drew additional information from the grey literature to identify areas for improvement in medical settings and at-risk patient groups. Technology-facilitated abuse concerns healthcare professionals from the point of consultation to the point of discharge, as a result clinicians need to be equipped with the tools to identify and address these harms at any stage of the patient's journey. In this article, we offer recommendations for further research within different medical subspecialities and highlight areas requiring policy development in clinical environments.
Project description:Food is Medicine (FIM) programs to improve the accessibility of fruits and vegetables (FVs) or other healthy foods among patients with low income and diet-related chronic diseases are promising to improve food and nutrition security in the United States (US). However, FIM programs are relatively new and implementation guidance for healthcare settings using an implementation science lens is lacking. We used a narrative review to describe the evidence base on barriers and facilitators to FIM program integration in US healthcare settings following the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework. Evidence surrounding the EPIS Inner Context was a focus, including constructs Leadership, Organizational Characteristics, Quality and Fidelity Monitoring and Support, Organizational Staffing Processes, and Individual Characteristics. Peer-reviewed and grey literature about barriers and facilitators to FIM programs were of interest, defined as programs that screen and refer eligible patients with diet-related chronic disease experiencing food insecurity to healthy, unprepared foods. Thirty-one sources were included in the narrative review, including 22 peer-reviewed articles, four reports, four toolkits, and one thesis. Twenty-eight sources (90%) described EPIS Inner Context facilitators and 26 sources (84%) described FIM program barriers. The most common barriers and facilitators to FIM programs were regarding Quality and Fidelity Monitoring and Support (e.g., use of electronic medical records for tracking and evaluation, strategies to support implementation) and Organizational Staffing Processes (e.g., clear delineation of staff roles and capacity); although, barriers and facilitators to FIM programs were identified among all EPIS Inner Context constructs. We synthesized barriers and facilitators to create an EPIS-informed implementation checklist for healthcare settings for use among healthcare organizations/providers, partner organizations, and technical assistance personnel. We discuss future directions to align FIM efforts with implementation science terminology and theories, models, and frameworks to improve the implementation evidence base and support FIM researchers and practitioners.
