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Why hospital doctors should cut back on blood tests

Doctors should reduce the number of repetitive blood tests they perform for hospital patients, report researchers.

The authors of the literature review also provide an evidence-based blueprint to guide hospitals in cutting unnecessary daily blood draws from clinically stable patients.

“Excessive blood draws can deplete a patient’s hemoglobin count, which often leads to repeat testing,” says coauthor Kevin Eaton, an internal medicine resident at the Johns Hopkins University Hospital.

Nearly 20 percent of hospitalized patients can develop moderate to severe hospital-acquired anemia, studies show. That, Eaton and his colleagues say, can generate additional tests, interventions, and costs for the patient.

Decreasing repetitive daily laboratory testing does not result in missed diagnoses or increase the number of readmissions to the hospital, the reviewers say.

Citing individual studies where front-line health care workers reduced lab tests by anywhere between 8 and 19 percent, the authors report that cost savings have ranged from $600,000 to more than $2 million per year.

While many professional societies recommend reducing repetitive lab tests, recommendations alone typically do not change doctors’ behavior, Eaton says. The most successful efforts to reduce daily lab testing found by the reviewers involved educating health care providers about costs, showing providers their ordering habits, and restricting automated repeat ordering of tests.

The blood test paper is the second study from the High Value Practice Academic Alliance, which includes nearly 90 academic medical centers collaborating to improve health care quality and safety by reducing unnecessary components of practice that do not add value to patient care.

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“Reducing unnecessary daily inpatient laboratory testing is only one small improvement, but doing so successfully can help change the culture of health care providers to be more keenly focused on thoughtful ordering and prescribing for their patients,” says Pam Johnson, an associate professor of radiology. She was not involved in the study, but leads the alliance.

Other authors of the paper are from Johns Hopkins University, the University of Michigan Medical School, Sinai Health System, Icahn School of Medicine at Mount Sinai, the University of Pennsylvania, Cedars-Sinai Medical Center, and the University of Virginia School of Medicine.

The review appears in JAMA Internal Medicine.

Source: Johns Hopkins University

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