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Evaluation of the Order SMARTT: An Initiative to Reduce Phlebotomy and Improve Sleep‐Friendly Labs on General Medicine Services
Author(s) -
Tapaskar Natalie,
Kilaru Megha,
Puri Tipu S,
Martin Shan K,
Edstrom Eve,
Leung Edward,
Ahmed Farah,
Kondo Ryuhei,
Norenberg Allison,
Poli Elizabeth,
Arora Vineet M
Publication year - 2020
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.12788/jhm.3423
Subject(s) - medicine , hospital medicine , sleep (system call) , sleep medicine , morning , phlebotomy , emergency medicine , medical emergency , family medicine , sleep disorder , psychiatry , insomnia , computer science , operating system
We assessed the effectiveness of a quality improvement project to reduce routine labs in clinically stable patients, while also promoting sleep‐friendly lab timing. The electronic health record was modified with an “Order Sleep” shortcut to facilitate sleep‐friendly lab draws. A “4 am Labs” column was added to electronic patient lists to signal which patients had early morning labs ordered. Among 7,045 patients over 50,951 total patient‐days, on average we observed 26.3% fewer routine lab draws per patient‐day per week postintervention (4.68 before vs 3.45 after; difference, 1.23; 95% CI, 0.82‐1.63; P < .05). In interrupted time series analysis, the “Order Sleep” tool was associated with a significant increase in sleep‐friendly lab orders per encounter per week on resident medicine services (intercept, 1.03; standard error (SE), 0.29; P < .001). The “4 am Labs” column was associated with a significant increase in sleep‐friendly lab orders per patient encounter per week on the hospitalist medical service (intercept, 1.17; SE, 0.50; P = .02). We demonstrate the success of an initiative to simultaneously reduce daily labs and improve sleep‐friendly ordering.