‘Choosing wisely’ raises the value of health care

National initiative provides road map for improving quality, patient experience

Physicians at The University of Vermont Medical Center are taking a “high-value care” approach to improving patient experiences while reducing risk and cost.

In June 2012, pulmonologist Polly Parsons, MD, chief of the Department of Medicine, challenged her faculty to submit ideas for high-value care projects using the American Board of Internal Medicine Foundation’s Choosing Wisely suggestions as examples.

We have the opportunity to draw blood without that additional needle stick.

Justin Stinnett-Donnelly, MD, Value Care Initiative coordinator

“The goal is to create a process for members of our provider and clinical community – those working at the bedside – to generate ideas on how to improve the value of the care that we deliver,” says Justin Stinnett-Donnelly, MD, Value Care Initiative coordinator for the department.

Stinnett-Donnelly, also a clinical assistant professor at Larner College of Medicine, gave an example of a current project: improving the care of dialysis inpatients. “Hospitalized chronic dialysis patients undergo treatment three times per week. They may have blood drawn early in the morning with a needle stick for laboratory monitoring, then move to dialysis, where their vascular system is accessed again. We have the opportunity to draw blood without that additional needle stick.”

Limiting phlebotomy reduces the patient’s pain and blood loss (dialysis patients have a reduced ability to make new red blood cells).

To address this opportunity, a group of physicians, nurses, phlebotomists, quality improvement specialists and members of the electronic health record staff worked to find ways to have non-urgent blood draws done during dialysis.

The department’s goal is to expand this process to other network hospitals.
Other completed projects include:

  • 72 percent reduction in the use of lab testing for levels of blood urea nitrogen and creatinine in hospitalized patients with end-stage renal disease who are on hemodialysis
  • 90 percent reduction in DXA bone-density scans on women older than 65 who had no documented clinical risk factors for early osteoporosis
  • 71 percent reduction in the use of portable chest X-rays in mechanically ventilated patients on days they were not intubated and had no procedures performed