Wait, wait, don’t stick me! Residents pilot intervention to reduce lab test overuse

Imagine you are a patient in a hospital. You’ve been receiving treatment for a few days and are starting to feel much better; your doctor even confirms that you are clinically stable and ready to go home the next day. But then, another doctor comes in and says they need to draw your blood for another lab test. What are they, vampires?

As crazy as it sounds, stable patients about to be discharged get their blood drawn all the time. Often lab tests are scheduled automatically, whether or not they are needed for a diagnosis. Unnecessary lab testing can lead to patient discomfort, false positives, overtreatment, and hospital-acquired anemia. And it’s incredibly wasteful – hospitals spend nearly $150 per patient per day on unnecessary lab testing. 

That’s why doctors at Mount Sinai Hospital in New York have developed a pilot program to reduce this unnecessary testing. Dr. Surafel Tsega and Dr. Harry Cho (co-chairs of the Right Care Alliance Hospital Medicine Council) led the Necessity of Labs Assessed Bedside (NO LABS) initiative, and the results of the pilot were recently published in the Journal of Hospital Medicine

The NO LABS initiative builds on Mount Sinai’s existing system of interdisciplinary rounds, where the hospitalist, social workers, nurses, and medical director go through patient cases together at the patient’s bedside. When patients are stable and ready for discharge, the medical director and nurses are prompted to remind the hospitalist to discontinue lab orders. Then the clinician can cancel the order automatically on the computer. 

This intervention is the first to use anticipated discharge as a prompt for discontinuation of lab testing. By involving many different members of the clinical team, as well as the patient, hospitalists are held accountable for stopping unnecessary tests. And having an opportunity to discontinue the order right at the bedside makes it easy for doctors to follow through. By the end of the year, the proportion of patients getting lab tests 24 hours before discharge had decreased from 50.1% to 34.5%.

Mount Sinai’s NO LABS program complements similar programs at McGill University and the University of California – San Francisco. McGill residents used a mindfulness strategy to stop automatic lab test continuation. UCSF’s program, “Think Twice, Stick Once,” used an interdisciplinary educational campaign to reduce unnecessary lab tests. These interventions offer models of change for doctors who are trying to curb lab testing, and demonstrate to other trainees that they can take action on overuse at their institution.