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Special Communication
Less Is More
December 2017

Evidence-Based Guidelines to Eliminate Repetitive Laboratory Testing

Author Affiliations
  • 1Department of Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
  • 2Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
  • 3Division of General Internal Medicine, Department of Medicine, Sinai Health System, Toronto, Ontario, Canada
  • 4Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  • 5Division of General Internal Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
  • 6The Michigan Medicine/Institute for Healthcare Policy and Innovation for Program on Value Enhancement, Ann Arbor
  • 7Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 8Division of Hospital Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
  • 9Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
  • 10Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 11Section of Hospital Medicine, Department of Internal Medicine, University of Virginia School of Medicine, Charlottesville
JAMA Intern Med. 2017;177(12):1833-1839. doi:10.1001/jamainternmed.2017.5152

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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