Study: Teaching hospitals routinely order more lab test than non-teaching hospitals

Major teaching hospitals treating patients for bacterial pneumonia or cellulitis routinely ordered more inpatient laboratory tests than non-teaching hospitals, even after controlling for severity of illness, length of stay and patient demographics, according to a study published in JAMA.

A team of researchers — led by Victoria Valencia, assistant director of healthcare value at the Dell Medical School at the University of Texas at Austin — analyzed data of 43,329 adults hospitalized with pneumonia or cellulitis at 11 major teaching hospitals, 12 minor teaching hospitals and 73 non-teaching hospitals in Texas to compare test-ordering patterns between teaching and non-teaching hospitals.

The report, titled "A Comparison of Laboratory Testing in Teaching vs. Nonteaching Hospitals for 2 Common Medical Conditions," presents information from a cross sectional study that used a Texas database to identify hospitalizations for bacterial pneumonia or cellulitis between January 2014 and January 2015 at hospitals with 100 or more hospitalizations for each condition. The researchers excluded patients who stayed in an intensive care unit, were transferred from another hospital or had a longer length of stay two standard deviations above the mean length of stay.

The researchers found that major teaching hospitals in Texas ordered an average of 13.2 laboratory tests per day, per patient for bacterial pneumonia, compared to non-teaching hospitals, which ordered an average of 8.9 tests per day per patient.  In addition, the same pattern occurs for cellulitis. Major teaching hospitals ordered an average 10.4 laboratory tests per inpatient per day for cellulitis in comparison to non-teaching hospitals, which ordered each patient an average of 7.3 tests per day. 

The researchers concluded that in Texas, patients admitted to major teaching hospitals with the two common infections received significantly more laboratory tests, but warn future research is needed to examine the cultural differences between training and non-training environments to determine how culture may increase laboratory use for conditions that do not often require lab testing. 

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