The Pathology Program has been on a productive journey in the Pathology Stewardship and Choosing Wisely initiatives.
Choosing Wisely – now under the Australian Commission on Safety and Quality in Health Care – continues to leave its mark within Monash Health Pathology under Professor Beena Kumar, Program Director of Pathology.
(L to R: Mr Robbie Gugasyan, A/P Zhong Lu, Prof Maryza Graham, Prof Beena Kumar, A/P Anjali Dhulia, Ms Gillian Yap, A/P Sanjeev Chunilal)
The success of this work, resulting in a reduction in duplicate and unnecessary tests in the health service, has been the outcome of well-coordinated teamwork between clinicians and scientists within the Pathology Program, the Chief Medical Officer, Associate Professor Anjali Dhulia and her team, which includes Ms Gillian Yap and Ms Devisri Dharmaraj and the EMR team lead by Mr Robert Gugasyan. The EMR Optimisation – Pathology Stewardship project team meets monthly to set priorities, focusing on frequently ordered unnecessary tests and initiating and facilitating hard and soft stops on EMR.
The team also engages directly with the clinicians ordering the tests and business managers.
Monetary savings and gains are not our only focus, but also the environmental impact due to unnecessary tests, the required consumables and reagents.
Unnecessary phlebotomy negatively impacts patient wellbeing. Blood loss from repeated blood draws is independently associated with Hospital Acquired Anaemia and may pose a higher risk of needlestick injuries or lead to overdiagnosis.
The project aims to embed the culture of reducing low-value and harmful care through better decision-making and challenges us to become better doctors.
The microbiology team led by Associate Prof Maryza Graham is ahead of others in this initiative.
The first Microbiology project was performed in conjunction with Prof David Armstrong and the Cystic Fibrosis team: cessation of routine susceptibility testing on repeat Pseudomonas aeruginosa isolates from patients with CF led to an estimated cost saving of around $7,000 over 17 months.
The second project involved the implementation of alerts in EMR to notify requesters when a Microbiology test had already recently been ordered and to suggest appropriate reordering time frames and indications: for six common tests the financial cost saving was over $100,000 and environmental cost saving by weight was estimated to be over 230kg in six months.
Cessation of unnecessary folate testing in biochemistry led by Associate Prof Zhong Lu, extrapolated savings per year of almost $20,000 on consumables; a reduction of 6,789 inpatient folate tests (a decrease from 7,168 in the first half to 379 inpatient folate tests in the second half of 2022).
The results of this initiative were presented at a National Conference, thus spreading this message to the broader community. The immunopathology team led by Dr Samar Ojaimi has successfully removed the vasculitis order set (encompassing 46 pathology tests) from EMR. This has already been shown to help reduce excessive test ordering. However, the impact on resources is still being evaluated.
Associate Professor Sanjeev Chunilal has been working with the EMR team to initiate a hard stop on duplicate requests for the two prevalent genetic mutations associated venous thrombosis, namely the Prothrombin gene mutation /factor V Leiden mutations.
The Anatomical Pathology team led by our scientists Alex Laslowski and Maria Chavez has made changes to historical work practices by replacing the conventional histolene, an expensive chemical used for tissue processing, that requires external contractors for waste removal as the waste cannot be discarded through the hospital sewerage system by a higher quality, less expensive, less toxic and environment-friendly Isopropanol (IPA). This has had a significant impact on the environment and our finances.
The Monash Choosing Wisely in Pathology journey has thus far been a great one. We thank the senior and junior doctors who have worked with us to achieve our goals. While the journey is underway, it is in its infancy, and we hope to continue to work together to steward pathology resources.
Approved by Anjali Dhulia