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Evidence-Based Guidelines to Eliminate Repetitive Laboratory Testing

ARTICLE: Evidence-Based Guidelines to Eliminate Repetitive Laboratory Testing

AUTHORS: Kevin P. Eaton, Kathryn Levy, Christine Soong, Amit K. Pahwa, Christopher Petrilli, Justin B. Ziemba, Hyung J. Cho, Rodrigo Alban, Jaime F. Blanck, Andrew S. Parsons

JOURNAL: JAMA Intern Med. 2017 Oct 16. doi: 10.1001/jamainternmed.2017.5152. [Epub ahead of print]


Routine daily laboratory testing of hospitalized patients reflects a wasteful clinical practice that threatens the value of health care. Choosing Wisely initiatives from numerous professional societies have identified repetitive laboratory testing in the face of clinical stability as low value care. Although laboratory expenditure often represents less than 5% of most hospital budgets, the impact is far-reaching given that laboratory tests influence nearly 60% to 70% of all medical decisions. Excessive phlebotomy can lead to hospital-acquired anemia, increased costs, and unnecessary downstream testing and procedures. Efforts to reduce the frequency of laboratory orders can improve patient satisfaction and reduce cost without negatively affecting patient outcomes. To date, numerous interventions have been deployed across multiple institutions without a standardized approach. Health care professionals and administrative leaders should carefully strategize and optimize efforts to reduce daily laboratory testing. This review presents an evidence-based implementation blueprint to guide teams aimed at improving appropriate routine laboratory testing among hospitalized patients.

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Kelsey Bennett