[Skip to Navigation]
Sign In
Editor's Note
August 2017

Routine Laboratory Tests in Hospitalized Patients—The Registered Nurse’s Role

Author Affiliations
  • 1University of California, San Francisco and San Francisco VA Medical Center, San Francisco
  • 2Deputy Editor, JAMA Internal Medicine
JAMA Intern Med. 2017;177(8):1207. doi:10.1001/jamainternmed.2017.1642

Professional organizations recommend against routinely obtaining common laboratory tests in hospitalized patients because such testing can result in harm associated with false positives, additional testing, overdiagnosis, and overtreatment.1 The survey of inpatient providers at Memorial Sloan Kettering Cancer Center by Roman et al2 suggests that routine laboratory testing remains common despite these recommendations. What we found most interesting about this article is that registered nurses were much more likely than other health care providers to value routine testing. Eighty percent of registered nurses believed that hospitalized patients should have daily laboratory testing, compared with 28% of attending physicians. Registered nurses do not generally order laboratory tests, but they are very important members of the inpatient hospital team, and their attitudes may influence ordering. In 2014, the American Academy of Nursing joined the American Board of Internal Medicine’s Choosing Wisely campaign. The list of activities to avoid included several related to hospitalized adults: not letting older hospitalized patients lay in bed or only get up to move to a chair, not using physical restraints for older hospitalized patients, not waking patients for routine care, and not placing or maintaining a urinary catheter without a specific indication.3 These are all evidence-based approaches to improve patient care, reduce harm, and reduce the cost of care. Perhaps the American Academy of Nursing should extend this list to not ordering routine laboratory tests in hospitalized patients as well.

Back to top
Article Information

Corresponding Author: Deborah Grady, MD, MPH, Department of Medicine, University of California, San Francisco and San Francisco VA Medical Center, 550 16th St, PO Box 0558, San Francisco, CA 94158 (deborah.grady@ucsf.edu).

Conflict of Interest Disclosures: None reported.

ABIM Foundation. Choosing Wisely. http://www.choosingwisely.org/resources/. Accessed November 21, 2016.
Roman  BR, Yang  A, Masciale  J, Korenstein  D.  Association of attitudes regarding overuse of inpatient laboratory testing and health care provider type  [published online June 12, 2017].  JAMA Intern Med. doi:10.1001/jamainternmed.2017.1634Google Scholar
ABIM Foundation. American Academy of Nursing Announces Engagement in National Choosing Wisely Campaign. http://www.choosingwisely.org/american-academy-of-nursing-announces-engagement-in-national-choosing-wisely-campaign/. Published October 16, 2014. Accessed May 3, 2017.