Hospital patients subjected to unnecessary lab tests

Repetitive lab testing of hospitalised patients is leading to additional unnecessary tests, interventions and costs for the patient, and should be stopped.

In a review article published in JAMA Internal Medicine, doctors at Johns Hopkins Hospital, along with experts from several other US institutions, crafted an experience-based quality improvement blueprint to reduce repetitive lab testing for hospitalised patients.

“Excessive blood draws can deplete a patient’s haemoglobin count, which often leads to repeat testing,” said Dr Kevin Eaton of Johns Hopkins. An estimated 20% of hospitalised patients can develop moderate to severe hospital-acquired anemia. This spiral, he and his co-authors assert, can generate additional unnecessary tests, interventions and costs for the patient. Moreover, the authors say, published studies show that decreasing repetitive daily laboratory testing did not result in missed diagnoses or increase the number of readmissions to the hospital.

Citing individual studies where frontline healthcare workers reduced the number of orders for lab tests by anywhere between 8% and 19%, the authors reported cost savings ranging from $770,000 to more than $2.5 million per year.

Dr Eaton said there have been previous recommendations to reduce repetitive lab tests, which hadn’t resulted in a change in behaviour; the study therefore provided recommendations to facilitate this.

The recommendations are as follows:

• Design hospital-wide educational initiatives backed by data to collectively outline and standardise best practice.
• Establish target numbers by which to reduce lab test ordering and provide instant feedback to those ordering tests to show their personal ordering patterns, so they are aware of their own behaviour with respect to agreed-upon standards.
• Reprogram the electronic systems used to order tests to restrict the number of ‘pre-ordered’ tests with an eye on having better reasons to order tests than just doing so daily.

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