Reducing Unnecessary Inpatient Laboratory Testing in a Teaching Hospital

TLDR

The study sought to reduce unnecessary inpatient laboratory testing by redesigning the electronic order system to restrict repeat phlebotomy requests to a single test or within a 24‑hour window. The redesigned order function was deployed in June 2003. After implementation, inpatient test volume fell 12 % (72,639 fewer tests), with 57.5 % of the savings from the five most frequently repeated tests, and phlebotomy counts dropped 21.4 %, enabling staff reallocation to outpatient services.

Abstract

After an inpatient phlebotomy–laboratory test request audit for 2 general inpatient wards identified 5 tests commonly ordered on a recurring basis, a multidisciplinary committee developed a proposal to minimize unnecessary phlebotomies and laboratory tests by reconfiguring the electronic order function to limit phlebotomy–laboratory test requests to occur singly or to recur within one 24-hour window. The proposal was implemented in June 2003. Comparison of fiscal year volume data from before (2002–2003) and after (2003–2004) implementation revealed 72,639 (12.0%) fewer inpatient tests, of which 41,765 (57.5%) were related directly to decreases in the 5 tests frequently ordered on a recurring basis. Because the electronic order function changes did not completely eliminate unnecessary testing, we concluded that the decrease in inpatient testing represented a minimum amount of unnecessary inpatient laboratory tests. We also observed 17,207 (21.4%) fewer inpatient phlebotomies, a decrease sustained in fiscal year 2004–2005. Labor savings allowed us to redirect phlebotomists to our understaffed outpatient phlebotomy service.