The goal of this stepped-wedge cluster randomized trial is to assess the impact of a laboratory test overuse intervention bundle on laboratory test utilization in 6 health authorities (16 hospitals) in British Columbia. The main question it aims to answer is if the intervention bundle, inclusive of healthcare provider and patient engagement tools, can be effectively implemented for hospitalized medical inpatients in 16 hospitals across BC and reduce laboratory test over-use. Researchers will compare hospital clusters that receive the intervention at different (sequential) time points to see if there are significant changes in the measured outcomes after the intervention.
Patients: The study will include all adult general medical patients that are admitted to the selected hospital during the study period under general internal medicine or family medicine (hospitalist) provider groups.
Attending Physicians: All physicians who provide patient care in the general internal medicine or family medicine (hospitalist) provider groups in selected hospitals
Learners and allied health staff (Medical Students/Resident physicians/Clinical Assistants/ Nurse Practitioners, etc.): All those who help take care of patients and can order labs during the study period in the under general internal medicine or family medicine (hospitalist) provider groups in selected hospitals The date range for both groups will extend from May 2024 until study completion in October 2026.
Patients: all patients in specialized medical units (e.g., coronary care, dialysis units, bone marrow transplants units etc.), in critical care, pediatric, obstetrical, surgical, and psychiatric units.
Patients and Health Care Providers (HCPs) who are not in the internal medicine or family medicine groups
Sequential
Laboratory test overuse (LTO) Bundle
BehavioralKey Components of the LTO Bundle: Educational materials, including an online module, clinical decision support tool, provision of lab utilization (Audit and Feedback) reports for healthcare providers. Patient engagement tools, such as videos and educational infographics. System level implementation tools adapted to the local context, including EMR-based tools and order set changes, etc.
Change in number of target laboratory tests ordered per patient-day with LTO bundle compared to control period without LTO bundle
The change in the number of the six target laboratory tests with the LTO bundle
Change in number of total laboratory tests ordered per patient-day with the LTO bundle
Change in the number of all common laboratory tests ordered during the study with the LTO bundle
Rate of hospital re-admissions and mortality
Rate of hospital re-admission and mortality rates over study period with LTO intervention bundle
Change in costs associated with routine laboratory testing
Change in costs associated with routine laboratory testing
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University of British Columbia
Lead sponsor
Providence Health & Services
Collaborator
Vancouver Coastal Health
Collaborator
Fraser Health
Collaborator
Interior Health
Collaborator
Northern Hospital, Australia
Collaborator
Canadian Institutes of Health Research (CIHR)
Collaborator
Island Health
Collaborator
