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Research Letter |

Hospital Care Efficiency and the SMART (Specific, Measurable, Agreed, Required, and Timely) Medicine Initiative

Ronen Zalts, MD1; Dana Ben-Hur, MD1; Ali Yahia, MD1; Jasmin Khateeb, MD1; Vera Belsky, BSc2; Nirit Grushko, BSc2; Gidon Berger, MD1
[+] Author Affiliations
1Division of Internal Medicine, Rambam Health Care Campus, Haifa, Israel
2Intel Electronics, Ltd, Haifa, Israel
JAMA Intern Med. 2016;176(3):398-399. doi:10.1001/jamainternmed.2015.7705.
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This article describes trends in the use of low-value diagnostic tests at a hospital after implementation of consensus recommendations developed by a team of physicians and engineers to reduce their use.

A considerable proportion of hospital resources is spent on various laboratory and imaging tests. This reality presents a significant challenge to medical teams with regard to intelligent and efficient use of these tools during hospital care.1 The SMART (Specific, Measurable, Agreed, Required, and Timely) Medicine initiative, conducted by the Division of Internal Medicine at the Rambam Health Care Campus, aims to improve the efficiency of medical investigations by making the use of diagnostic tools more precise, focused, and based on the clinical findings.

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Figure 1.
Rates of Measurement of B-type Natriuretic Peptide (BNP) and Troponin Levels

Recommendations were released in March 2014 for measurement of BNP levels in the workup of acute dyspnea and of troponin levels in the workup of acute chest pain. Use of both tests declined significantly (P < .001).

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Figure 2.
Rates of Measurement of Amylase, Creatine Kinase (CK), and Lactic Dehydrogenase (LDH) Levels

Recommendations were released in July 2014 for unbundling of a panel chemistry workup. A significant reduction in routine testing of LDH, amylase, and CK levels resulted (P < .001).

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