Journal Article

Re-Purposing the Ordering of Routine Laboratory Tests in Hospitalized Medical Patients (RePORT): protocol for a multicenter stepped-wedge cluster randomised trial to evaluate the impact of a multicomponent intervention bundle to reduce laboratory test over-utilization

Harrison, Mark, Ambasta, Anshula, Ma, Irene, Pokharel, Surakshya, Kassam, Narmin, Santana, Maria, Mathura, Pamela, Naugler, Chris, Omodon, Onyebuchi, Manns, Braden, Shukalek, Caley, McCaughey, Deirdre, Shih, Andrew Wei-Yeh, Stelfox, Henry T., Faris, Peter, Holroyd-Leduc, Jayna M., Williamson, Tyler

2024

Overview

Background Laboratory test overuse in hospitals is a form of healthcare waste that also harms patients. Developing and evaluating interventions to reduce this form of healthcare waste is critical. We detail the protocol for our study which aims to implement and evaluate the impact of an evidence-based, multicomponent intervention bundle on repetitive use of routine laboratory testing in hospitalized medical patients across adult hospitals in the province of British Columbia, Canada. Methods We have designed a stepped-wedge cluster randomized trial to assess the impact of a multicomponent intervention bundle across 16 hospitals in the province of British Columbia in Canada. We will use the Knowledge to Action cycle to guide implementation and the RE-AIM framework to guide evaluation of the intervention bundle. The primary outcome will be the number of routine laboratory tests ordered per patient-day in the intervention versus control periods. Secondary outcome measures will assess implementation fidelity, number of all common laboratory tests used, impact on healthcare costs, and safety outcomes. The study will include patients admitted to adult medical wards (internal medicine or family medicine) and healthcare providers working in these wards within the participating hospitals. After a baseline period of 24 weeks, we will conduct a 16-week pilot at one hospital site. A new cluster (containing approximately 2–3 hospitals) will receive the intervention every 12 weeks. We will evaluate the sustainability of implementation at 24 weeks post implementation of the final cluster. Using intention to treat, we will use generalized linear mixed models for analysis to evaluate the impact of the intervention on outcomes. Discussion The study builds upon a multicomponent intervention bundle that has previously demonstrated effectiveness. The elements of the intervention bundle are easily adaptable to other settings, facilitating future adoption in wider contexts. The study outputs are expected to have a positive impact as they will reduce usage of repetitive laboratory tests and provide empirically supported measures and tools for accomplishing this work. Trial Registration This study was prospectively registered on April 8, 2024, via ClinicalTrials.gov Protocols Registration and Results System (NCT06359587). https://classic.clinicaltrials.gov/ct2/show/NCT06359587?term=NCT06359587&recrs=ab&draw=2&rank=1

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Audit and Feedback / Audits / British Columbia / Clinical trials / Cluster Analysis / Councils / Diagnostic Tests, Routine / Education / Electronic health records / Evaluation / Feedback / Health Administration / Health care waste / Health Informatics / Health Policy / Health Promotion and Disease Prevention / Health Services Research / Hospitalization / Hospitalization - statistics & numerical data / Hospitals / Humans / Implementation / Implementation Science / Intervention / Laboratories / Low value testing / Management / Medical records / Medical research / Medical tests / Medical wastes / Medicine / Medicine & Public Health / Methods / Multicenter Studies as Topic / Patients / Physicians / Pilot projects / Professional development / Public Health / Qualitative research / Randomized Controlled Trials as Topic / Routine laboratory testing / Social comparison / Study Protocol / Surgeons / Unnecessary Procedures - statistics & numerical data