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Preventing Duplicate Laboratory Testing

Preventing Duplicate Laboratory Testing

Unwarranted duplicate laboratory tests have been shown to increase unnecessary phlebotomy, which can lead to iatrogenic anemia and associated sequelae, such as poor wound healing and a greater risk of infections. Such tests can also decrease patient satisfaction and increase healthcare costs. Although some phlebotomists understand when to consolidate orders, doing so requires approval from ordering physicians and consumes a considerable amount of time. Addressing the Problem For a study published in the American Journal of Clinical Pathology, Gary W. Procop, MD, MS, FASCP, FCAP, and colleagues sought to limit duplicate testing at the Cleveland Clinic. The team previously observed that it was ineffective to only include pop-up alerts in the computerized physician order entry (CPOE) system that warned physicians about a duplicate order. “We demonstrated that pop-up fatigue is real,” says Dr. Procop. “Only rarely did physicians read the alert. Many times, they simply clicked through the alert to close it and move on to their next task.” After agreeing on more than 1,200 tests that a multidisciplinary test utilization committee felt was not needed more than once per day, a hard stop was programmed into the CPOE. The hard stop made it impossible for physicians to order any of these tests through the computer system, if they had already been ordered that day. “The physician requesting a duplicate test would receive an alert notifying them that the test had already been ordered, and the system also provided the test result if it was available,” Dr. Procop explains. “We also built a workaround scenario in case physicians felt like they absolutely needed a duplicate test. They had to...
The Paucity of Doctor Leaders in Medicine

The Paucity of Doctor Leaders in Medicine

Changes are happening in the healthcare system whether we like it or not, from the ACA to the Physician Quality Reporting System, or PQRS. Many doctors are not happy with these changes. Yet, there are few that lead us to affect change. Many doctors are simply too busy and lack time. Others just do not know how to lead. For years, we are trained to just do what others tell us. We have all served as scut monkeys in our early years of residency. However, this mentality is leading to physician burnout. We can no longer just sit back while non-physician executives and politicians dictate healthcare. How can doctors take back the lead? 1. Attend local meetings at the hospital. Speak up at hospital committees and demand change. Most of us just accept our hospital’s by-laws without even reading them. The vast majority of us oppose MOC, yet if our hospitals are requiring it for us to maintain our privileges, it will never go away. 2. Become active with local medical associations. Many doctors feel the larger ones, such as the AMA, have sold us out to politicians and do not truly represent the physician members. We have more of a chance to make change on a smaller, local lever first. Speak with the representatives and let them know what physicians need and want. 3. Doctors are increasingly frustrated by 3rd party payment hassles. Many sign the participating physician contracts without reading them or knowing what is written in them. This makes it harder for others to negotiate a more reasonable arrangement. Doctors need to stop doing this. We...
Managing Older Patients With HIV

Managing Older Patients With HIV

In 2015, more than half of people with HIV in the U.S. will be aged 50 or older, according to Wayne McCormick, MD, MPH. “By 2025, the median age is projected to be 60 years old.” The aging HIV population has been due in large part to the success of antiretroviral therapy (ART). “Unfortunately, ART has many side effects that need to be taken into account when managing patients with HIV,” says Dr. McCormick. “Even with successful ART, patients with HIV still have an inflammatory infection. As they live longer, questions are raised about how to manage the comorbidities that are associated with HIV as well as those associated with aging.” A Helpful Initiative To address the unique issues of aging patients with HIV, members of the American Academy of HIV Medicine, the AIDS Community Research Initiative of America, and American Geriatrics Society created and launched www.hiv-age.org. The website was designed by these trusted organizations to allow for ongoing discussion about clinical care and research around HIV and aging. It is also intended to provide ways to share new and emerging infor­mation in this area. The HIV-Age website can help clinicians who seek best practices to care for older patients with HIV as well as interested patients, advocates, and researchers. “We wanted this information to be ‘live’ on the web so that it can be a living document that is changeable based on the ongoing conversations and emerging knowledge,” explains Dr. McCormick. “When research is published in hard copy, it can sometimes become fixed in time. Having a dedicated website allows us to quickly and easily update and correct...
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