Lessons Learned and Successes from Lab Test Utilization Initiatives at Mount Sinai Hospital

50 Pages·2015·2.82 MB·English

by  Seipp, Melissa L.

Lessons Learned and
Successes from Lab
Test Utilization
Initiatives at
Mount Sinai Hospital
Ila Singh, MD, PhD
Vice Chair of Clinical Pathology
Director of Clinical Laboratories
Mount Sinai Health System
New York , NY
Casey Leavitt, MBA
Director, Consultative Services
ARUP Laboratories
Salt Lake City, UT
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1
The Mount Sinai Health System
New York
The Mount Sinai Hospital
Mount Sinai Queens
Mount Sinai Beth Israel
Mount Sinai Beth Israel Brooklyn
Mount Sinai Roosevelt
Mount Sinai St. Luke’s
New York Eye and Ear Infirmary
of Mount Sinai

3500 beds
55 ambulatory care centers

2.6 million outpatient visits
170,000 inpatient admissions
18 million billable tests/year
|
2
ARUP Laboratories
More Than a Lab
• Privately held
70
• Nonprofit enterprise of
the University of Utah
and its Department of
Pathology
medical directors and
consultants provide
• Does not compete with
collaboration clients for physician
office business
|
3
Institute of Medicine study
"Unnecessary lab tests
cost an average hospital
$1.7 million a year."
|
ABIM Foundation Survey
Physicians reported:
the frequency of the average
unnecessary tests medical doctor
73% and procedures is 72% prescribes an
a very or unnecessary test or
somewhat serious procedure at least
problem once a week.
their patients ask
that even if they
for an unnecessary
know a medical test
test or procedure
53% is unnecessary, they 47%
at least once a
order it if a patient
week
insists
ABIM Foundation. Survey: Physicians Aware Many Tests and Procedures are Unnecessary, See |
Themselves as Solution. 2014. http://www.abimfoundation.org/News/ABIM-Foundation-
News/2014/choosing-wisely-survey-release.aspx 5
Physicians appear to be uncertain when
ordering Lab Tests
Study of 1,768 US primary care physicians reveals 1 :
15% 8
%
of the time they are of the time they are
uncertain about which test uncertain about
to order interpreting the results
1. Primary Care Physicians’ Challenges in Ordering Clinical Laboratory Tests
6
and Interpreting Results, Journal of the American Board of Family Medicine,
|
Mar-Apr, 2014
With more than 500 million
primary care patient visits each
year, this potentially affects

23 million patients per year
|
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Why the uncertainty?
Laboratory tests More than 3,500
Reduced,
Lab Medicine teaching

hours in medical school sometimes to zero
How do clinicians compensate for this
uncertainty?
Order more tests

Use the ‘H and L’ approach
|
8
But is more testing better?

Horseracing Handicappers
Graph courtesy of Brian Jackson, MD,
CMIO, ARUP Laboratories
Slovic, P. Unpublished manuscript,
cited in Hueur R.J., Psychology of
Intelligence Analysis
|
utilization
management
Road
Map
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10
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