Doctors, stop sticking your patients so many times for redundant blood work during their hospital stays, especially when results won’t affect your clinical decisions.
Daniel Wheeler, MD
It’s not always so urgent. Blood draws add costs, and it’s not so much fun for patients to get poked with a sharp needle multiple times a day. I know it would make me grouchy.
Besides, you might be causing or hastening their anemia.
Those are among the themes in the UCSF Medical Center’s “Think Twice, Stick Once” campaign that began last July through the efforts of young University of California, San Francisco internal medicine house staff doctors led by Daniel Wheeler, MD.
The practice of testing patients’ blood every morning, every evening, and sometimes repeatedly in between—an average of more than twice per day—has evolved in hospital practice over decades, regardless of patients’ condition or fragility, says Wheeler, a third-year resident slated to be chief resident starting in June.
Today, there’s a general consensus that some of those blood draws are unnecessary, yet the repeat lab work beat goes on in most organizations around the country, he says.
So when last year’s UCSF Medical Center residents huddled to decide on a quality improvement project, they picked this one. “We all felt that phlebotomy was so common, it could be very easily reduced in a safe manner,” Wheeler says
A quick 10% decrease in blood tests
Launched last June, the project initially aimed to reduce blood draws among medical service patients by 5% in the 2014-2015 academic year, compared to the prior year when draws averaged 2.1 per patient per day. Obstetric, pediatric, surgical, and ICU patients are excluded because such patients may have more rapid fluctuations.
So far the team is way ahead of its goal. As of the five months since October 1, Wheeler says, the hospital’s electronic database shows the count is down 10%, from 2.1 draws per day to 1.9.
“That doesn’t seem like a huge change, but when you’re working with an intervention that happens with as much frequency as phlebotomy, you’re talking about a lot.”
A draw on patient experience scores
Besides, says Wheeler, continual venipunctures are so annoying to patients that they’re believed to drag down patient experience scores, which can affect up to 30% of a hospital’s standing in the federal value based-purchasing program, which now affects up to 1.5% of Medicare payments, and up to 2% starting in October of 2016.
“Phlebotomy blood draws are not very pleasant. They require being poked with a needle, sometimes at odd hours of the day or night while they’re resting or sleeping. And it’s uncomfortable.”
Hospital leadership, he says, got on board quickly with the Think Twice, Stick Once campaign.
Throughout the units, posters hang in resident work areas, while red buttons sporting the slogan have been distributed to internal medicine residents and interns.
The campaign seeks to prompt doctors “to ask ourselves, for each patient, ‘will the result of this particular test affect the way I care for this patient?” Wheeler adds.
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