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Reducing Unnecessary Inpatient Laboratory Testing in a Teaching Hospital

Todd A. May MD, Mary Clancy CLS, MS, Jeff Critchfield MD, Fern Ebeling RN, Anita Enriquez RN, Carmel Gallagher RN, Jim Genevro, Jay Kloo RN, Paul Lewis RN, Rita Smith RN, Valerie L. Ng PhD, MD
DOI: http://dx.doi.org/10.1309/WP59YM73L6CEGX2F 200-206 First published online: 1 August 2006

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.

Key Words:
  • Informatics
  • Economic evaluation
  • Clinical pathology
  • Phlebotomy
  • Management
  • Administration
  • Generalist