Preliminary results presented recently at a Society for Hospital Medicine conference indicate use of the iCal at UCSF has dropped by 50% after about six months. Use of nebulizers, which require a respiratory therapist, after the first 24 hours, was also reduced by more than 50% with a project called Nebs No More After 24. And inappropriate stress ulcer prophylaxis was reduced by more than 25% in the ICU.
At least three other interventions are underway with optimistic results not yet ready for report, including an effort to move appropriate patients from step-down units to regular inpatient beds faster, to transition appropriate patients from intravenous to oral medications more quickly, and to remove IVs when not clinically indicated.
The UCSF Cost Awareness curriculum, which Moriates designed while still a resident, has grown to include a six-pronged project run by the High Value Care Committee. This is a group of 20 doctors, co-chaired by Moriates, which is trying to trim institutionalized, but wasteful practices throughout UCSF. And spread the word to other hospitals too.
But first, a little more explanation about the $20 iCal. Moriates says that at UCSF until May of 2012, and still at many other hospitals, blood is routinely drawn, sometimes multiple times per patient, for a separate lab process to check levels of ionized calcium, though only a few patients (those with parathyroid disease or end-stage renal disease or who have too high calcium levels due to cancer) really need the test.