Prevent duplication to have better test utilization.

From the 2019 HVPAA National Conference

Dr. Shivani Malhotra (University of Alabama at Birmingham Hospital), Dr. Parekha Yedla (University of Alabama at Birmingham Hospital), Mr. Shae Ferguson (Huntsville Hospital), Mr. Richard Ivey (Huntsville Hospital)


Duplicate lab testing is a common problem in hospitals. The duplicate tests ordered may be unnecessary and contribute to patient discomfort and increased health care cost with no change in patient outcome.


To educate and change physician ordering behavior for duplicate labs including HbA1C, TSH and Vitamin D, 25-Hydroxy incorporating principles of high value care.


  • A 6-month review was performed at an 879-bed tertiary care center, identifying duplicate tests performed for patients during a hospital stay. Using ordering physicians’ identification numbers, data were extracted for pre-intervention, intervention and post intervention periods (two months each).
  • Data were then divided by providers in the intervention group versus a comparison group. Group 1 included patients admitted to the Family Medicine service, Internal Medicine service and the hospitalist group. Group 2 included patients admitted to all other services.
  • Lab tests included in this study were HbA1C, TSH and Vitamin D, 25-Hydroxy.
  • Physicians on the Family Medicine, Internal Medicine and hospitalist services were educated on the core principles of high value care as defined by ACP’s Choosing Wisely Campaign through morning report sessions, email reminders, didactics sessions, handouts and a grand rounds presentation.
  • Subsequently, analysis was completed to compare performance of duplicate lab testing in the post intervention period.


  • Rate of duplicate HbA1c orders was lower in Group 1 as compared to Group 2 with p-value < 0.0001.
  • Rate of duplicate TSH orders was lower in Group 1 as compared to Group 2 with p-value= 0.0085.
  • Rate of duplicate Vitamin D, 25-Hydroxy orders was lower in Group 1 as compared to Group 2 with p-value < 0.0001.
  • There was relative reduction in the A1C­ duplicate test from pre to post intervention periods in group 1.Although this wasn’t quite statistically significant (p-value = 0.134), the relative reduction was 32% (from 3.97% to 2.71%).


Our study demonstrates that there is a statistically significant benefit from physician education in preventing duplicate test orders.

Clinical Implication

Ongoing physician education is needed to see a significant change in physician ordering pattern and cost reduction.


What are academic medical centers across the country doing to improve healthcare value?

Value improvement guides: Published reviews in JAMA Internal Medicine coauthored by experienced faculty from multiple leading medical centers, with safety outcomes data and an implementation blue print.

Review article detailing 25 labs to refine for high value quality improvement | July 2020

MAVEN campaign: Free 4 year high value care curriculum online.

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