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Experts recommend fewer lab tests for hospitalized patients.

In a review article publishing recently in JAMA Internal Medicine, physicians at the Johns Hopkins University, along with experts from several other institutions across North America, compiled published evidence and crafted an experience-based quality improvement blueprint to reduce repetitive lab testing for hospitalized patients.

Repeated blood draws for such tests can lead to hospital-acquired anemia and other complications. This is 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 do not add value to patient care.

Experts have estimated that nearly 20 percent of hospitalized patients can develop moderate to severe hospital-acquired anemia as a result of repeated blood draws. This spiral can generate additional unnecessary tests, interventions, and costs for the patient. 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 where frontline healthcare workers reduced the number of orders for lab tests by anywhere between eight percent and 19 percent, the authors reported 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. The most successful efforts to reduce daily lab testing in this 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.

The recommendations are as follows: Design hospital-wide educational initiatives backed by data to collectively outline and standardize 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 behavior with respect to agreed-upon standards; and reprogram the electronic systems used to order tests to restrict the number of "pre-ordered" tests.

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Title Annotation:Diagnostics
Publication:Medical Laboratory Observer
Geographic Code:1USA
Date:Dec 1, 2017
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