November 2, 2017

Experts Recommend Fewer Lab Tests for Hospitalised Patients

BALTIMORE, Md -- November 2, 2017 -- In a review article published in JAMA Internal Medicine, experts compiled published evidence and crafted an experience-based quality improvement blueprint to reduce repetitive lab testing for hospitalised patients.

Repeated blood draws for such tests can lead to hospital-acquired anaemia 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 centres collaborating to improve healthcare quality and safety by reducing unnecessary components of practice that do not add value to patient care.

“Excessive blood draws can deplete a patient’s haemoglobin count, which often leads to repeat testing,” said Kevin Eaton, MD, Johns Hopkins Hospital, Baltimore, Maryland.

Others have estimated that nearly 20% of hospitalised patients can develop moderate to severe hospital-acquired anaemia. 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, according to the authors.

While many professional societies have recommended reducing repetitive lab tests, recommendations alone typically do not change behaviour. 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 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.

Reference: DOI:10.1001/jamainternmed.2017.5152

SOURCE: Johns Hopkins Medicine

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