From the 2024 HVPA National Conference
Binita Ghosh MD (SSM Saint Mary’s), Saira Ibrahim MD
Background:
The debate over the necessity of daily laboratory tests for hospitalized patients is central to the quest for high-value care. Routine daily lab tests are common, yet often do not significantly improve patient outcomes and may lead to negative consequences such as iatrogenic anemia, sleep disturbances, additional unnecessary tests to investigate incidental abnormalities, and ultimately, decreased patient satisfaction. Existing studies collectively emphasize the importance of educating medical trainees and revising policies to improve test utilization.
Methods:
We conducted a study at a community hospital-based residency program during the 2023-2024 academic year. Educational initiatives included dedicated grand rounds focused on high-value practices and targeted noon conferences to encourage prudent lab test use in various clinical contexts. The number of morning lab tests ordered was measured over specified periods before and after these educational interventions.
Results:
Our data analysis demonstrated a significant reduction in the number of morning laboratory orders, which decreased from 512 to 277 following the interventions. Measurements were taken over identical 13-week periods before and after the interventions. This 46% reduction can be attributed to educational sessions emphasizing the limited utility of daily lab tests and also by periodically showing residents the data that was being collected.
Discussion:
In this ongoing study, future objectives include implementing system-based changes, such as modifications to order sets and electronic medical record notifications, and assessing the financial impact of these interventions. The findings advocate for integrating a high-value care curriculum and quality improvement projects in residency programs, particularly those focusing on laboratory testing in hospital medicine. The aim is to cultivate patient care practices among residents that align with Choosing Wisely initiatives.