Ditch FOMO and Choose Wisely

Do you experience FOMO (fear of missing out) when ordering labs, diagnostics and chest X-rays for your critically ill patients? Are you programmed to order as many tests as possible to ensure you don’t miss anything?

Although your intentions are genuine, think about how much these tests cost your facility and, more importantly, your patient; the figures can be astronomical. However, practicing “high-value healthcare” can help rein in costs by simply stopping and thinking, “Does this patient really need this test?”

“There are small and very meaningful, highly impactful things that nurse practitioners can do each and every day that impact the value of care, particularly from the patient’s perspective,” said April Kapu, associate chief nursing officer, Vanderbilt University Medical Center’s Office of Advanced Practice, and associate professor of clinical nursing, Vanderbilt University School of Nursing in Nashville, Tennessee, during Tuesday’s session, “APRNs: Impacting High-Value Care at a National Level and Beyond.” “If the patient doesn’t need a particular test, why order it? Why add to that patient’s cost?”

“We really should be practicing more with a view toward cost and what is essential to provide patient care without ordering excessive tests and procedures,” adds Ruth M. Kleinpell, assistant dean for clinical scholarship, Independence Foundation chair for nursing education, and professor, Vanderbilt University School of Nursing. “That’s the bottom line when talking about high-value care.”

Eliminating some tests may be difficult for nurses with FOMO, but Kapu and Kleinpell encouraged attendees to embrace the concept-turned-campaign, Choosing Wisely, a collaborative of interdisciplinary medical teams founded in 2012 by the American Board of Internal Medicine Foundation.

What began with six APRN teams at Vanderbilt examining the financial impact of ordering fewer tests became a nationwide, 16-team effort across 13 states by September 2017, with funding from an American Association of Nurse Practitioner Fellows grant. Interim results already show significant impacts. In fact, one cardiovascular ICU that once had a chest X-ray ordering rate of 130 percent has effectively reduced its facility’s costs $50,000 per month by “choosing wisely.” This demonstrates the level of influence APRNs can have on high-value healthcare.

“APRNs and nurses can be leaders in value-based healthcare, and they certainly can showcase the impact of their roles by leading these initiatives along with their multiprofessional partners,” Kleinpell says.