Bedside Assessment of the Necessity of Daily Lab Testing for Patients Nearing Discharge

Abstract

As part of the Choosing Wisely® campaign, the Society of Hospital Medicine recommends against performing "repetitive complete blood count chemistry testing in the face of clinical and lab stability." With this recommendation as a framework, we targeted 2 hospitalist-run inpatient medicine units that employed bedside, scripted, interdisciplinary rounds. Our multifaceted intervention included prompting the hospitalist to identify clinically stable patients for next-day discharge and to discontinue labs when appropriate. It was coupled with the education of the clinicians and a regular data review for the hospitalists and unit staff. Among 2877 discharges included in a 1-year period, there was a significantly decreasing trend after the intervention in the percentage of patients getting labs in the 24, 48, and 72 hours before discharge (-1.87%, -1.47%, and -0.74% decrease per month, respectively; P < 0.05). Our structured, multifaceted approach effectively reduced daily lab testing in the 24 to 48 hours prior to discharge.

Signage as an intervention on a general medicine ward to reduce unnecessary testing

“…Many published studies exist examining ways to reduce unnecessary testing and other unnecessary interventions 2–4 . However, the methods used in these studies are time‐ and resource‐intensive, often requiring regular educational sessions, restrictive ordering and practice audits with regular feedback.…”

“…One study showed that a combination of practitioner education, pocket‐sized reference cards and signage at computer stations significantly reduced the rate of inappropriate treatment in asymptomatic bacteriuria 3 . Another recent study showed that prompting the physician to identify stable patients close to discharge, combined with education and regular data review and feedback, resulted in a trend of decreased testing in the 72 h before discharge over the course of a year 4 . A recent systematic review examined interventions attempting to reduce unnecessary testing; the majority involved practitioner educational sessions, displaying the cost of tests and restrictive ordering and had a statistically significant, although sometimes transient, effect on practice 2 …”

Later Morning Phlebotomy and the Potential Effect on Early Discharge

“…We wholeheartedly agree with the importance of patient-centric models for routine blood draws, as only a few have been described in the literature. 3,4 This effort could reduce nonurgent disruptions to sleep and be received favorably by not only patients but also phlebotomists and nurses who are tasked with waking patients for painful needle sticks.…”