Morning complete blood counts and metabolic panels have been a routine for many hospitals, but leaders are rethinking which patients actually need routine blood work and are putting precautions in place to help break habitual lab orders, Medscape reported Sept. 8.
Concerns over hospital-acquired anemia, cost, patient sleep disruption and unnecessary resource utilization have prompted many hospitals to rethink daily lab testing and its value for patients.
Here is what to know.
1. Daily laboratory testing remains appropriate for patients hospitalized with heart failure, infections, chronic obstructive pulmonary disease exacerbations, myocardial infarction, postoperative complications, bleeding events, complications of diabetes, unstable electrolyte abnormalities, acute kidney injury, substantial diuresis, medications requiring close laboratory monitoring, or rapidly evolving critical illness, leaders told Medscape. For stable patients with normal lab values and no new issues, the risks of daily labs may outweigh the benefits.
2. Studies like CBCs, basic and comprehensive metabolic panels, magnesium, phosphorus, and coagulation are frequently ordered as routine daily tests. CBCs and metabolic panels are the most frequently overused lab studies, along with A1c, serial inflammatory markers and infectious disease tests.
3. Many clinicians order lab studies out of habit, and tests ordered out of habit are often the easiest to request together. Reminding physicians to order fewer tests can change this. Electronic health records can help eliminate automatic recurring lab orders, prompt clinicians to indicate the reason for a test to interrupt habitual ordering and reinforce evidence-based practices by alerting clinicians when testing falls outside of guidelines.
4. Research has found reducing unnecessary lab testing does not compromise patient safety. Associations like the Society of Hospital Medicine have also launched campaigns to help reduce repetitive CBCs and chemistry testing in clinically stable patients.
5. Leaders told Medscape the top question to ask about labs is: Is the result likely to change what we do for this patient today?
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