Teaching residents systems-based practice through a hospital cost-reduction program: A "win-win" situation

Background: The Accreditation Council for Graduate Medical Education (ACGME) Outcome Project challenges residency programs to teach and evaluate competence in 6 domains, including systems-based practice (SBP). One element of SBP is to "practice cost-effective health care ... that does not compromise quality.". Institutional cost-reduction efforts included targeting laboratory fees by using point-of-care testing with an iSTAT® machine rather than in the central laboratory. Predicted cost savings were $50,000 per month. Because residents are primary users of laboratory resources, the authors engaged them in the process and implementation of system redesign. Description: The residents identified barriers to use of the iSTAT® and solutions to overcome those barriers. Evaluation: As a result of resident solutions, use of the iSTAT® went from 40% of potential iSTAT® tests being ordered on the iSTAT® to 98%, with an estimated $549,780 per year in savings to the hospital. Conclusion: Involving residents in hospital cost-reduction efforts allows both teaching and evaluation of competence in SBP while realizing significant cost savings.