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Comment & Response
Less Is More
March 2018

Evidence-Based Guidelines to Eliminate Repetitive Laboratory Testing?—Reply

Author Affiliations
  • 1Division of Hospital Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
  • 2Section of Hospital Medicine, Department of Internal Medicine, University of Virginia School of Medicine, Charlottesville
JAMA Intern Med. 2018;178(3):431-432. doi:10.1001/jamainternmed.2017.8531

In Reply We thank Bindraban et al for their comments and concerns regarding our article,1 and we agree that not all components (education, targeted feedback, electronic medical record [EMR] change) may be needed to reduce daily testing. In the article by May et al2 that was mentioned in their Letter to the Editor, the intervention used was EMR based, allowing only single orders for laboratory testing (ie, no recurring orders). This may be a feasible method in some institutions, but not all have the buy-in from key clinical groups and administrators to enact such a change. At Mount Sinai Hospital, for example, we have not yet had institution-wide approval for limiting recurring orders, and the EMR constraints preclude our ability to even limit recurring orders for specific groups who do approve. Based on discussions among our multi-institutional committee and others, we suspect we are not alone, and many have implemented EMR changes that are less than ideal, including removing recurring order defaults from order sets, or placing best practice advisory warnings.