Reducing Incomplete 3rd Trimester Labs: A Multi-Modal Approach [2Q]

INTRODUCTION: The goal of 3rd trimester labs is to provide the optimal information to ensure a healthy mother and neonate. We estimated that 2% of patients at our institution were missing 3rd trimester labs prior to delivery. Our objective was to reduce the rate of missed 3rd trimester labs employing Best Practice Advisories (BPA) and other modalities in the inpatient and outpatient setting. METHODS: Inventions included (1) creation of an Epic-based Best Practice Advisory (BPA) in clinic and on admission to encourage providers to order the labs when missing, (2) changes to admission H&P to make the 3rd trimester labs more visible, (3) education of nursing and providers, and (4) an additional L&D Grease board column for 3rd trimester labs. These interventions were launched Feb 2018. An internal reporting system was used to report missing labs before and after the intervention. The rate of missing were compared before and after the intervention and feedback was elicited from the L&D team (nurses, midwives, residents, attendings). RESULTS: The average rate of missed labs was 2.8 per month prior the intervention. Rates of missed labs appear to have increased after the intervention (3.5 per month). It is unclear if increased awareness led to increased error reporting. Overall, the rate of missed 3rd trimester labs at our institution is 1.4% (28 misses/2066 deliveries). CONCLUSION: An approach that included EPIC-based BPA, provider and nurse education, and changes to note templates in the ambulatory and inpatient setting, resulted in no measurable improvement in the rates of missed 3rd trimester labs.