Redundant, duplicate, or unneeded laboratory testing is also common in the inpatient setting. Testing on inpatients is often excessive. Audits from hospital systems have shown that patients often get multiple draws for the same test automatically, regardless of whether their status has changed.
The electronic medical record (EMR) and changes to phlebotomy/lab policies seem to hold the most promise as tools for reducing excessive ordering on the same patient. These are examples of policies that could be effective if enforced.
- Orders for multiple serial testing within a 24-hour period only remain valid within one 24-hour window. All inpatient orders expire after 24 hours. Physician orders that span more than 24 hours will not be honored (instruct physicians to write orders for only one 24-hour period).
- Serial phlebotomies performed by the inpatient phlebotomists are restricted to limited intervals of every 4, 6, or 12 hours.
- Standing orders or orders for future days are not accepted.
- EMR functionality now exists to alert providers that the test they are about to order has already been ordered in the past. This duplicate-order checking is a great tool that is currently underused.
The UM team can get quick data concerning inpatient lab draws by simply looking at random patients who have been admitted and stayed at the hospital for three days or more. Plot the number of times each test was performed during the patient's stay. You can easily get a picture of how many draws and tests are done on the average patient. It is not uncommon for some inpatients to have 15 CBC panels done in 3-5 days time, or five liver function panels done over 1-2 days. It's also very interesting to note that most of these lab values, even in sick patients, seldom change significantly over the time the patient is in the hospital. Physicians are often surprised when they see this type of data and can be motivated to order less testing in the future.
