Effect of implementing measures to reduce resource utilisation in medical wards (CopAIN project): a single-centre interrupted time-series analysis

BACKGROUND: Initiatives like "Choosing Wisely" promote efficient and high-quality healthcare by reducing overuse. The interdisciplinary copAIN project aims to reduce resource utilisation in medical ward patients by providing specific guidelines to internal medicine residents. METHODS: This study was conducted in the Cantonal Hospital Aarau, a 500-bed tertiary care and academic facility.After implementing the copAIN project for medical inpatients on 1 June 2023, we conducted an interrupted time-series (ITS) cohort study and analysed it using a mixed-effects regression model for comparison. Neurological patients not involved in copAIN served as the control group. The primary outcome was resource utilisation defined by the measurement frequency of five vital signs and laboratory orders. The secondary, safety outcome was in-hospital mortality. RESULTS: Of 51,396 admissions between 1 September 2022 and 31 May 2024, 8344 cases were eligible for analysis. While there were no differences in measurement frequencies in the control group, we found a significant reduction in the intervention group for the frequency of measurements of blood pressure (0.28 measures per day per length of stay [dLOS]), heart rate (0.26 measures per dLOS), oxygen saturation (0.28 measures per dLOS) and temperature (0.27 measures per dLOS). However, this effect was temporary, and adjusted analyses showed no significant difference between pre- and post-intervention periods. There was no change in mortality between study periods in both groups. CONCLUSION: An intervention focusing on the reduction of routine parameters within the hospital settingresulted in a temporary decrease in resource use without increasing in-hospital mortality. This data supports recent initiatives aimed at improving resource efficiency in medicine without compromising quality. The absence of a sustained impact highlights the need for ongoing strategies to maintain and reinforce improvements.