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. https://doi.org/10.12788/jhm.3129

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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. http://doi.org/10.1016/j.annemergmed.2018.06.041

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. http://doi.org/10.1001/jamasurg.2018.1565

Levinson, W., Born, K., & Wolfson, D. (2018). Choosing Wisely Campaigns: A work in progress. JAMA, 5–6. http://doi.org/10.1001/jama.2018.2202

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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. http://doi.org/10.1093/ajcp/aqx159

Carroll, A. E. (2017). The high costs of unnecessary care. JAMA - Journal of the American Medical Association, 318(18), 1748–1749. http://doi.org/10.1001/jama.2017.16193

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. http://doi.org/10.1001/jamainternmed.2017.5152

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. http://doi.org/10.1016/j.amjmed.2017.02.014

Morgan, D. J., Dhruva, S. S., Wright, S. M., & Korenstein, D. (2016). 2016 Update on Medical Overuse. JAMA Internal Medicine, 176(11), 1687. http://doi.org/10.1001/jamainternmed.2016.5381

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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. http://doi.org/10.1016/j.amjmed.2015.09.009

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. http://doi.org/10.1093/ajcp/aqv092

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. http://doi.org/10.1016/j.amjmed.2016.06.020

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. http://doi.org/10.1093/ajcp/aqx054

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. http://doi.org/10.5858/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. http://doi.org/10.1001/jamainternmed.2017.6369

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. http://doi.org/10.1016/j.amjmed.2017.02.029

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. http://doi.org/10.1016/j.amjmed.2017.01.011

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. http://doi.org/10.1309/AJCPYXDAUS2F8XJY

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. http://doi.org/10.1309/AJCPJOJ3HKEBD3TU

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. http://doi.org/10.1309/LM2JVTWX8TKCURMF

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. http://doi.org/10.1177/1062860613517502

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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. http://doi.org/10.1309/AJCPOWHOIZBZ3FRW

Yeh, D. D. (2014). A clinician’s perspective on laboratory utilization management. Clinica Chimica Acta; International Journal of Clinical Chemistry, 427, 145–50. http://doi.org/10.1016/j.cca.2013.09.023

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