More on Quality and Safety

Ordering fewer lab tests can improve quality and lower costs

Studies show that decreasing repetitive daily laboratory testing did not result in missed diagnoses or increase the number of readmissions.

Jeff Lagasse, Associate Editor

Physicians at Johns Hopkins, along with experts from several other institutions across North America, have compiled evidence and crafted an experience-based quality improvement blueprint to reduce repetitive lab testing for hospitalized patients, which they say can contribute to unnecessary costs.

Repeated blood draws for such tests can lead to hospital-acquired anemia and other complications, according to the research, published in Internal Medicine, a journal of the American Medical Association.

[Also: How unnecessary tests, scans, procedures and surgeries are affecting your patients]

It's the second paper co-authored by residents and faculty from the High Value Practice Academic Alliance, a consortium of nearly 90 academic medical centers collaborating to improve healthcare quality and safety by reducing unnecessary components of practice that don't add value to patient care.

Unnecessary blood draws can deplete a patient's hemoglobin count, often leading to repeat testing, the research found. And an estimated 20 percent of hospitalized patients can develop moderate to severe hospital-acquired anemia. This spiral, the authors contend, can generate additional unnecessary tests, interventions and costs.

[Also: Unnecessary medical tests, treatments cost $200 billion annually, cause harm]

Moreover, 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 in which front-line healthcare workers reduced the number of orders for lab tests by anywhere between 8 and 19 percent, the authors said that cost savings have ranged from $600,000 to more than $2 million per year.

While many professional societies have recommended reducing repetitive lab tests, recommendations alone typically do not change behavior, they said. The most successful efforts to reduce daily lab testing in the review included a combination of educating healthcare providers about charges, obtaining feedback by showing providers' ordering habits and changing clinical workflow to restrict automated repeat ordering of tests.

Among the recommendations are that hospital leaders should design hospital-wide educational initiatives backed by data to collectively outline and standardize best practices. They should also establish target numbers by which to reduce lab test ordering and provide instant feedback to those ordering tests to show their personal ordering patterns; that way, they're aware of their own behavior with respect to agreed-upon standards.

It was also recommended to 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.

Twitter: @JELagasse
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