Minimizing daily laboratory testing strategically and systematically may reduce preventable harm to patients and will lower overall hospital costs, according to a paper published in JAMA Internal Medicine.
Investigators report that routine laboratory testing is consistently associated with preventable harms. Hospital-acquired anemia, for instance, can occur if patients undergo multiple testing procedures. The researchers note that failure to consider pretest disease probability prior to routine testing limits the tests’ prognostic value and could result in additional and sometimes unnecessary subsequent interventions.
The investigators suggest the implementation of a 3-point algorithm for minimizing daily laboratory testing that may reduce hospital expenditures and improve overall patient care.
First, hospitals should design a standardized testing protocol that will be implemented throughout the entire institution. This design should “target a multidisciplinary audience across all departments and services that care for hospitalized patients.” Information should be tailored to every healthcare professional, including nurses, residents, and attending physicians.
Second, hospitals should provide feedback to physicians about their ordering patterns. Additionally, high users of laboratory testing services should be encouraged to create a personalized strategy to minimize repetitive ordering practices. Finally, repetitive laboratory testing functionalities should be restricted in all electronic ordering sets in an effort to reduce unnecessary tests. Clinicians should also be encouraged to “engage in reflective ordering patterns based on clinician indication review.” Ultimately, these actions may help increase targeted testing.
The investigators suggest that the reduction of daily laboratory testing may “catalyze a commitment to improve high-value practices across the whole enterprise, which ultimately will result in improved safety, satisfaction, and cost-effectiveness for all stakeholders.”
Eaton KP, Levy K, Soong C, et al. Evidence-based guidelines to eliminate repetitive laboratory testing [published online October 16, 2017]. JAMA Intern Med. doi: 10.1001/jamainternmed.2017.5152