Surgical Vampires – a brief successful intervention to lower lab costs

Dark bars represent new interns on the ward. Click to enlarge
I know, this won’t generate the number of hits that the CDC got when it provided a step-by-step manual to prepare for an onslaught of flesh-eating zombies!   But the title is irresistible.

A colleague pointed out that there was a small interesting study in this month's Archives of Surgery   entitled “Surgical vampires and rising health care expenditure.”

The researchers simply told surgical interns and residents how much was being spent on daily laboratory tests per person on three surgical wards at Rhode Island Hospital.  Then, they calculated the daily charges, which started at over $140 per person, and settled closer to $120.

This was a small study, and only lasted 11 weeks. There is no long-term followup.  When a new group of interns rotated onto these wards, the costs went up again (represented by darker blue bars in the graph above). 

The researchers missed some major benefits from their intervention. One is that patients were stuck with fewer phlebotomy needles. They lost less blood, but more importantly, they suffered less discomfort.  Further, aberrant but self-correcting or erroneous abnormalities were not identified, which could have saved patients from unnecessary follow-ups, some of which could have involved imaging or other diagnostic tests not captured in this study.  The worst outcome from an unnecessary test is when it leads to more unnecessary tests!

The researchers provided only the charges, not the actual price paid by payers.  The price paid to the hospital probably didn’t change at all, since most patients were on Medicare or other health plans that pay DRG (diagnosis related group) bundled payments for hospitalization.  The costs seen by the system were probably, therefore, unchanged.   

Further, the marginal costs for a hospital to perform a few more laboratory tests are probably quite small.  A hospital doing 1000 complete blood counts per day saves very little in the way of laboratory supplies if it is only doing 990!. There are some potential savings in personnel, so there could have been less phlebotomist overtime due to this intervention.

Putting the reins on surgical vampires is not a silver bullet – but stopping doing unnecessary tests is a good idea.