Re-Purposing the Ordering of Routine Laboratory Tests in Hospitals in British Columbia (RePORT-BC)

Re-Purposing the Ordering of Routine Laboratory Testing in Hospitalized Medical Patients in British Columbia

The goal of this stepped-wedge cluster randomized trial is to assess the impact of a laboratory test overuse intervention bundle on laboratory test utilization in 6 health authorities (16 hospitals) in British Columbia. The main question it aims to answer is if the intervention bundle, inclusive of healthcare provider and patient engagement tools, can be effectively implemented for hospitalized medical inpatients in 16 hospitals across BC and reduce laboratory test over-use. Researchers will compare hospital clusters that receive the intervention at different (sequential) time points to see if there are significant changes in the measured outcomes after the intervention.

Study Overview

• Status: Recruiting
• Conditions: Hospital Acquired Condition
• Intervention / Treatment: Behavioral: Laboratory test overuse (LTO) Bundle

Detailed Description

This study aims to reduce unnecessary laboratory test use in hospitals using a stepped-wedge cluster randomized trial design. Over-use of laboratory testing in hospitals leads to patient discomfort, disruption of sleep patterns, and is associated with hospital-acquired anemia. The specific tests that the investigators focus on are complete blood count, electrolytes, creatinine, urea, international normalized ratio and partial thromboplastin time. After the initial control period, the investigators will begin with a pilot-phase for a feasibility assessment of the intervention tools. The intervention bundle will then be rolled out sequentially, one cluster (each cluster containing 2-3 hospitals) at a time in 12-week implementation steps.

The intervention bundle will contain tools to promote education around appropriate use of laboratory testing in hospitals (using an online module, clinical decision support tool), will share data on laboratory test utilization patterns locally, and include patient engagement materials (infographic and video).

Local champions in hospitals will form multidisciplinary implementation teams to facilitate adaptation and delivery of implementation tools within local context. A pragmatic stepped-wedge design will be used to implement the intervention bundle in 16 hospitals grouped into 8 clusters.

The first 4 weeks of implementation will be a pre-intervention period, trialing and adapting tools to the local context. Readiness assessments and workflow observations will be conducted to understand organizational readiness for implementation. Clusters will enter the intervention period during the latter 8 weeks of the implementation period where intervention tools will be deployed.

Data will be collected for at least 24 weeks post-implementation, evaluating the impact of tools without dedicated personnel support. Access to educational resources will continue, and laboratory utilization reports will be sent.

• Study Type: Interventional
• Enrollment (Estimated): 700000
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Anshula Ambasta; Phone Number: 4036184586; Email: anshula.ambasta@ubc.ca

Study Locations

• Canada
  • British Columbia
    • Prince George, British Columbia, Canada, V2M 1S2
      • Recruiting
      • University Hospital of Northern British Columbia
      • Contact: Anurag Singh
    • Vancouver, British Columbia, Canada, V6Z 1Y6
      • Recruiting
      • St. Paul's Hospital
      • Contact: Anshula Ambasta
    • Vancouver, British Columbia, Canada, V5T3N4
      • Recruiting
      • Mount St. Joseph's Hospital
      • Contact: Alyssa Shariff
    • Vancouver, British Columbia, Canada, V5Z1N1
      • Recruiting
      • Vancouver General Hospital
      • Contact: Penny Tam

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Participants involved in this study include the following groups: patients and healthcare providers (including learners, physicians and allied health staff)

Inclusion Criteria:

• Patients: The study will include all adult general medical patients that are admitted to the selected hospital during the study period under general internal medicine or family medicine (hospitalist) provider groups.
• Attending Physicians: All physicians who provide patient care in the general internal medicine or family medicine (hospitalist) provider groups in selected hospitals
• Learners and allied health staff (Medical Students/Resident physicians/Clinical Assistants/ Nurse Practitioners, etc.): All those who help take care of patients and can order labs during the study period in the under general internal medicine or family medicine (hospitalist) provider groups in selected hospitals The date range for both groups will extend from May 2024 until study completion in October 2026.

Exclusion Criteria:

• Patients: all patients in specialized medical units (e.g., coronary care, dialysis units, bone marrow transplants units etc.), in critical care, pediatric, obstetrical, surgical, and psychiatric units.
• Patients and Health Care Providers (HCPs) who are not in the internal medicine or family medicine groups

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Sequential Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention Arm (Intervention Bundle Implementation); This arm involves the time periods of the hospital units where the LTO bundle, including healthcare provider and patient engagement tools, is actively implemented.	Behavioral: Laboratory test overuse (LTO) Bundle; Key Components of the LTO Bundle: Educational materials, including an online module, clinical decision support tool, provision of lab utilization (Audit and Feedback) reports for healthcare providers. Patient engagement tools, such as videos and educational infographics. System level implementation tools adapted to the local context, including EMR-based tools and order set changes, etc.
No Intervention: Control Arm (No LTO Bundle Implementation); This arm represents the time period of hospital units where the LTO bundle is not implemented.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in number of target laboratory tests ordered per patient-day with LTO bundle compared to control period without LTO bundle	The change in the number of the six target laboratory tests with the LTO bundle	3 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in number of total laboratory tests ordered per patient-day with the LTO bundle	Change in the number of all common laboratory tests ordered during the study with the LTO bundle	3 years
Rate of hospital re-admissions and mortality	Rate of hospital re-admission and mortality rates over study period with LTO intervention bundle	3 years
Change in costs associated with routine laboratory testing	Change in costs associated with routine laboratory testing	3 years

Collaborators and Investigators

• Sponsor: University of British Columbia
• Collaborators: Canadian Institutes of Health Research (CIHR); Fraser Health; Providence Health & Services; Vancouver Coastal Health; Interior Health; Northern Hospital, Australia; Island Health
• Investigators: Principal Investigator: Anshula Ambasta, University of British Columbia

Publications and helpful links

General Publications

• Ambasta A, Holroyd-Leduc JM, Pokharel S, Mathura P, Shih AW, Stelfox HT, Ma I, Harrison M, Manns B, Faris P, Williamson T, Shukalek C, Santana M, Omodon O, McCaughey D, Kassam N, Naugler C. Re-Purposing the Ordering of Routine Laboratory Tests in Hospitalized Medical Patients (RePORT): protocol for a multicenter stepped-wedge cluster randomised trial to evaluate the impact of a multicomponent intervention bundle to reduce laboratory test over-utilization. Implement Sci. 2024 Jul 2;19(1):45. doi: 10.1186/s13012-024-01376-6.

Study record dates

Study Major Dates

• Study Start (Actual): May 6, 2024
• Primary Completion (Estimated): November 16, 2026
• Study Completion (Estimated): November 16, 2026

Study Registration Dates

• First Submitted: April 8, 2024
• First Submitted That Met QC Criteria: April 8, 2024
• First Posted (Actual): April 11, 2024

Study Record Updates

• Last Update Posted (Actual): May 7, 2026
• Last Update Submitted That Met QC Criteria: April 30, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Pathological Conditions, Signs and Symptoms; Iatrogenic Disease
• Other Study ID Numbers: H22-03005 (University of British Columbia)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No