Improving the way a business operates can contribute to the bottom line. But in the case of the healthcare industry, improving workflow can save lives.
That’s the findings of a group of studies reported in Health IT Analytics. They write:
Researchers found that simple behavioral interventions for clinical staff (providers) could slash the number of unnecessary antibiotic prescriptions.
The providers experienced one or more behavioral interventions that either suggested alternatives to antibiotic use through the electronic order set, prompted providers to enter free-text justifications for their antibiotic prescriptions in the electronic health record, or sent emails to participants comparing their prescribing rates with top-performing peers.
These “nudges” helped reduce antibiotic prescribing rates significantly. The control group decreased antibiotic prescriptions from 21.1 percent to 13.1 percent. Providers who received alternative suggestions reduced prescription rates from 22.1 percent to 6.1 percent, while those asked to provide justification for their actions slashed their antibiotic use from 23.2 percent to just 5.2 percent at the end of the study period.
Let’s break down how this works. Usually, hospital staff give prescriptions for antibiotics in an attempt to prevent or slow the growth of infections. But this method can be a little scattershot. To quote the press release from the University of Southern California:
Nationally, there are over 22 million inappropriate prescriptions for acute respiratory infections each year. This means many doctors are prescribing antibiotics to patients who have the common cold, even though antibiotics are ineffective against viruses.
“Antibiotics are overprescribed in the United States, which has made antibiotic-resistant infections a huge concern,” said Jeffrey A. Linder, the lead study physician at General Medicine and Primary Care at Brigham and Women’s Hospital who is also an assistant professor at Harvard Medical School. “There is an urgent need for interventions that safely decrease inappropriate prescribing.”
How did the studies generate better results? They tried three techniques:
As a provider, you have options besides prescribing antibiotics. There are a variety of tests you can do to determine the type of problem—including whether or not antibiotics will even be effective. The best course of action might be increased fluids, an over-the-counter medication, or simply rest. Sometimes these take additional time or require additional diagnostic work. But given the general overprescription of antibiotics, alternatives are worth considering.
The study tried communicating to the provider that they consider alternatives whenever they made the prescription. In effect the automated computer system said: “Before you order antibiotics for this patient, have you considered these other ideas?” That question alone had an impact on the results.
Writing Your Justification
A second experiment that improved antibiotic prescription rates was to ask the medical professional to type up their reasons for ordering this drug. As they place the order in the computer system, a pop-up window asks them to justify why they want it.
Just like asking if they had thought about alternatives, requiring providers to write out a few opinions gives them pause. And as a result, they are less likely to overprescribe.
The final technique came in the form of emails regularly sent to providers. These would indicate the prescription rates of their colleagues, thus encouraging them to be more conservative. When you know what other people are doing, you may feel a sense of competition. In the end, that may cause you to take a moment and make a better choice.
Small Changes, Big Effects
This experiment proves what we’ve been saying about workflow: a little bit of thinking goes a long way. And in the case of medicine, it can help to save lives.
In the case of antibiotics, the link is complex. That’s because overprescription is contributing to antibiotic resistant bacteria rather than hurting patients directly. But in all areas of business, reviewing what we do and how we do it is worthwhile. There are smarter ways to work. We need to be smart, however, to find them.