An initiative in Israel that included systematic feedback and monitoring helped reduce the use of common laboratory and other diagnostic tests.

During the first year, the hospital involved in the program had a 20 percent reduction in laboratory tests performed, saved $250,000 and decreased the laboratory turnaround time from sample receipt to results dispatch.

Lead researcher Ronen Zalts, MD, of Rambam Health Care Campus in Haifa, and colleagues published their results online in JAMA: Internal Medicine on Feb. 1.

In this initiative, known as SMART (Specific, Measurable, Agreed, Required and Timely) Medicine, senior physicians at the Rambam Health Care Campus met monthly with a content expert and engineers from Intel who participated in a voluntary, nationwide community involvement program.

After each meeting, the group drafted recommendations that were sent to all physicians in the hospital’s internal medicine division. They then continuously monitored data on blood and imaging tests.

In 2014, the group compiled recommendations for common laboratory, imaging and blood tests. They found that measuring B-type natriuretic peptide levels and troponin levels was significantly reduced. Physicians also reduced the use of routine measurements for lactic dehydrogenase, creatine kinase and amylase levels by more than 50 percent and decreased the number of tests ordered for C-reactive protein, hemoglobin A1c and thyrotropin levels.

“Although the selected topics may not be generalizable beyond the scope of our division’s practice, the guiding principles of the method can be applied in other settings,” the researchers wrote. “In addition to cost-effectiveness, SMART Medicine has contributed to patient safety by avoiding unnecessary exposure to radiation, contrast media, incidental findings, and false-positive results. In summary, SMART Medicine represents a milestone in the development and implementation of a defined method for wiser use of diagnostic tools.”