Journal Articles

HVC Featured Article

Routine daily laboratory testing of hospitalized patients reflects a wasteful clinical practice that threatens the value of health care. Choosing Wisely initiatives from numerous professional societies have identified repetitive laboratory testing in the face of clinical stability as low value care. Although laboratory expenditure often represents less than 5% of most hospital budgets, the impact is far-reaching given that laboratory tests influence nearly 60% to 70% of all medical decisions. Excessive phlebotomy can lead to hospital-acquired anemia, increased costs, and unnecessary downstream testing and procedures. Efforts to reduce the frequency of laboratory orders can improve patient satisfaction and reduce cost without negatively affecting patient outcomes. To date, numerous interventions have been deployed across multiple institutions without a standardized approach. Health care professionals and administrative leaders should carefully strategize and optimize efforts to reduce daily laboratory testing. This review presents an evidence-based implementation blueprint to guide teams aimed at improving appropriate routine laboratory testing among hospitalized patients.

High value care/ Utilization management Articles

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Trumbo, S. P., Iams, W. T., Limper, H. M., Goggins, K., Gibson, J., Oliver, L., Leverenz, D. L., Samuels, L. R., Brady, D. W., Kripalani, S. (2019). Deimplementation of routine chest x-rays in adult intensive care units. Journal of Hospital Medicine.

Oren, O., Kebebew, E., & Loannidis, J. P. (2019). Curbing unnecessary and wasted diagnostic imaging. JAMA - Journal of the American Medical Association.

Morgan, D. J., Dhruva, S. S., Coon, E. R., Wright, S. M., & Korenstein, D. (2018). 2018 Update on Medical Overuse. JAMA Internal Medicine, 175(1), 120–4.

Lim MY, Greenberg CS (2018). Inpatient thrombophilia testing: Impact of healthcare system technology and targeted clinician education on changing practice patterns. Vasc Med.;23(1):78-79. doi:10.1177/1358863X17742509

Korenstein, D., Chimonas, S., Barrow, B., Keyhani, S., Troy, A., & Lipitz-Snyderman, A. (2018). Development of a Conceptual Map of Negative Consequences for Patients of Overuse of Medical Tests and Treatments Supplemental content. JAMA Intern Med, 1–7.

Patel, M. S., Volpp, K. G., & Asch, D. A. (2018). Nudge Units to Improve the Delivery of Health Care. New England Journal of Medicine, 378(3), 214–216.

Heekin, A. M., Kontor, J., Sax, H. C., Keller, M. S., Wellington, A., & Weingarten, S. (2018). Choosing Wisely clinical decision support adherence and associated inpatient outcomes. The American Journal of Managed Care, 24(8), 361–366. Retrieved from

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Maughan, B. C., Rabin, E., Cantrill, S. V, & ACEP Quality and Patient Safety Committee Workgroup on Choosing Wisely. (2018). A Broader View of Quality: Choosing Wisely Recommendations From Other Specialties With High Relevance to Emergency Care. Annals of Emergency Medicine, 72(3), 246–253.

Goel, R., Patel, E. U., Cushing, M. M., et al (2018). Association of Perioperative Red Blood Cell Transfusions With Venous Thromboembolism in a North American Registry. JAMA Surgery, 153(9), 826–833.

Levinson, W., Born, K., & Wolfson, D. (2018). Choosing Wisely Campaigns: A work in progress. JAMA, 5–6.

Schiff GD, Martin SA, Eidelman DH, Volk LA, Ruan E, Cassel C, et al (2018). Ten Principles for More Conservative, Care-Full Diagnosis. Ann Intern Med. [Epub ahead of print ]

Waibel, E., Garcia, E., Kelly, M., Soles, R., & Hilborne, L. (2018). Systematic Review of Non-ASCP Choosing Wisely Recommendations Relevant to Pathology and Laboratory Medicine. Am J Clin Pathol, (March), 267–274.

Carroll, A. E. (2017). The high costs of unnecessary care. JAMA - Journal of the American Medical Association, 318(18), 1748–1749.

Eaton, K. P., Levy, K., Soong, C., Pahwa, A. K., Petrilli, C., Ziemba, J. B., … Parsons, A. S. (2017). Evidence-Based Guidelines to Eliminate Repetitive Laboratory Testing. JAMA Internal Medicine, 177(12), 1833–1839.

Kotecha, N., Shapiro, J. M., Cardasis, J., & Narayanswami, G. (2017). Reducing Unnecessary Laboratory Testing in the Medical ICU. American Journal of Medicine, 130(6), 648–651.

Morgan, D. J., Dhruva, S. S., Wright, S. M., & Korenstein, D. (2016). 2016 Update on Medical Overuse. JAMA Internal Medicine, 176(11), 1687.

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Iturrate, E., Jubelt, L., Volpicelli, F., & Hochman, K. (2016). Optimize Your Electronic Medical Record to Increase Value: Reducing Laboratory Overutilization. American Journal of Medicine, 129(2), 215–220.

Konger, R. L., Ndekwe, P., Jones, G., Schmidt, R. P., Trey, M., Baty, E. J., … Bashir, C. M. (2016). Reduction in Unnecessary Clinical Laboratory Testing Through Utilization Management at a US Government Veterans Affairs Hospital. American Journal of Clinical Pathology, 145(3), 355–64.

Litkowski, P. E., Smetana, G. W., Zeidel, M. L., & Blanchard, M. S. (2016). Curbing the Urge to Image. The American Journal of Medicine, 129(10), 1131–1135.

Rudolf, J. W., Dighe, A. S., Coley, C. M., Kamis, I. K., Wertheim, B. M., Wright, D. E., … Baron, J. M. (2017). Analysis of Daily Laboratory Orders at a Large Urban Academic Center: A Multifaceted Approach to Changing Test Ordering Patterns. American Journal of Clinical Pathology, 148(2), 128–135.

Zhou, Y., Procop, G. W., & Riley, J. D. (2017). A Novel Approach to Improving Utilization of Laboratory Testing. Archives of Pathology & Laboratory Medicine, 73104, arpa.2017-0031-OA.

Sadana, D., Pratzer, A., Scher, L. J., Saag, H. S., Adler, N., Volpicelli, F. M., … Frank, S. M. (2017). Promoting High-Value Practice by Reducing Unnecessary Transfusions With a Patient Blood Management Program. JAMA Internal Medicine.

Sadowski, B. W., Lane, A. B., Wood, S. M., Robinson, S. L., & Kim, C. H. (2017). High-Value, Cost-Conscious Care: Iterative Systems-Based Interventions to Reduce Unnecessary Laboratory Testing. American Journal of Medicine, 130(9), 1112.e1-1112.e7.

McDonald, E. G., Saleh, R. R., & Lee, T. C. (2017). Mindfulness-Based Laboratory Reduction: Reducing Utilization Through Trainee-Led Daily ‘Time Outs.’ American Journal of Medicine, 130(6), e241–e244.

Morgen, E. K., & Naugler, C. (2015). Inappropriate repeats of six common tests in a Canadian city: A population cohort study within a Laboratory Informatics framework. American Journal of Clinical Pathology, 144(5), 704–712.

Procop, G. W., Keating, C., Stagno, P., Kottke-Marchant, K., Partin, M., Tuttle, R., & Wyllie, R. (2015). Reducing duplicate testing: a comparison of two clinical decision support tools. American Journal of Clinical Pathology, 143(5), 623–6.

Signorelli, H., Straseski, J. A., Genzen, J. R., Walker, B. S., Jackson, B. R., & Schmidt, R. L. (2015). Benchmarking to Identify Practice Variation in Test Ordering: A Potential Tool for Utilization Management. Laboratory Medicine, 46(4), 356–64.

Vidyarthi, A. R., Hamill, T., Green, A. L., Rosenbluth, G., & Baron, R. B. (2015). Changing Resident Test Ordering Behavior. American Journal of Medical Quality, 30(1), 81–87.

Colla, C. H. (2014). Swimming against the current--what might work to reduce low-value care? The New England Journal of Medicine, 371(14), 1280–3.

Procop, G. W., Yerian, L. M., Wyllie, R., Harrison, A. M., & Kottke-Marchant, K. (2014). Duplicate laboratory test reduction using a clinical decision support tool. American Journal of Clinical Pathology, 141(5), 718–723.

Yeh, D. D. (2014). A clinician’s perspective on laboratory utilization management. Clinica Chimica Acta; International Journal of Clinical Chemistry, 427, 145–50.

May, T. A., Clancy, M., Critchfield, J., Ebeling, F., Enriquez, A., Gallagher, C., … Ng, V. L. (2006). Reducing unnecessary inpatient laboratory testing in a teaching hospital. American Journal of Clinical Pathology, 126(2), 200–206.