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

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.

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.