GRAPEVINE, TX—New strategies for conserving physician time and health care spending captured awards in the abstract competition at the annual meeting of the Society of Hospital Medicine, held here last week.
Choosing from almost 700 abstract submissions, a panel of hospitalist judges selected three as the “Best of Research, Innovations and Clinical Vignettes in 2011” and had the authors present their work during a plenary conference session.
Researchers at Johns Hopkins experimented with notifying physicians about the cost of lab tests. For a random selection of either expensive or commonly used tests, the computer order entry system was modified to list the price of the test. After six months, the study authors compared the change in use of those tests with a group of similar tests that didn't have listed prices. While cost on the control tests stayed the same or went up, spending on seven of the priced tests went down by at least $25,000, including a savings of about $135,000 on complete metabolic panels. “We saved about $486,000,” in total, said study co-author Leonard Feldman, FACP. Further research is needed to determine whether the effect could be maintained over a longer period and with prices listed for all tests instead of only a few, he added.
At the University of California San Francisco Benioff Children's Hospital, researchers looked at how compliance with shortened resident duty hours affected length of stay and cost of hospitalization. The pediatric medical service converted from a call model with cross coverage to a shift system with dedicated night teams. The change reduced interns' shifts from 30 hours to 13. An analysis of patients with the most common medical diagnoses found an 18% reduction in length of stay (LOS) and an 11% reduction in costs after the change, while a control group of surgery patients had no change in LOS and a cost increase. The results are good news for programs that will have to spend money to comply with the new duty-hour regulations coming this summer, according to lead author Glenn Rosenbluth, MD. “These costs may be partially offset by improved care efficiency,” he said.
The third winner was a project at Denver Health to re-engineer an academic medical service using Toyota production system tools. The service had also been using the traditional call model, and allowing teams to determine their days off by preference, resulting in very uneven workloads and frequent handoffs. They switched to a shift system with two “firms” of six interns and three residents on at a time. The new system increased continuity, so that more than 70% of patients had all their progress notes written by the same intern, and when handoffs were necessary, they were expected and better handled. “This system created excellent collaboration between interns,” said lead author Diana Mancini, MD.
—Stacey Butterfield, Associate Editor