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Reducing unnecessary testing: an intervention to improve resident ordering practices
  1. Jose Melendez-Rosado1,
  2. Kristine M Thompson2,
  3. Jed C Cowdell3,
  4. Catalina Sanchez Alvarez3,
  5. Ryan L Ung4,
  6. Armando Villanueva3,
  7. Kayin B Jeffers3,
  8. Jaafer S Imam3,
  9. Mario V Mitkov3,
  10. Tasneem A Kaleem3,
  11. Lewis Jacob3,
  12. Nancy L Dawson5
  1. 1 Division of Gastroenterology, Cleveland Clinic Florida, Florida, USA
  2. 2 Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida, USA
  3. 3 Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
  4. 4 Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, Florida, USA
  5. 5 Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
  1. Correspondence to Dr Nancy L. Dawson, Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA; dawson.nancy11{at}


Purpose of the study To reduce the number of unnecessary laboratory tests ordered through a measurement of effects of education and cost awareness on laboratory ordering behaviour by internal medicine residents for common tests, including complete blood cell count (CBC) and renal profile (RP), and to evaluate effects of cost awareness on hospitalisation, 30-day readmission rate and mortality rate.

Study design 567 patients admitted during February, March and April 2014 were reviewed as the control group. Total CBC, CBC with differential and RP tests were counted, along with readmission and mortality rates. Interventions were education and visual cost reminders. The same tests were reassessed for 629 patients treated during 12 months after intervention in 2015.

Results Data showed a significant increase in CBCs ordered after the intervention (mean number per hospitalisation changed from 1.7 to 2.3 (p<0.001)), a decrease in CBCs with differential (mean number changed from 1.7 to 1.2 (p<0.001)) and no change in RPs ordered (mean number, 3.7 both before and after intervention (p=0.23)). No change was found in mortality rate, but the decrease in the readmission rate was significant (p=0.008).

Conclusions Education in the form of cost reminders did not significantly reduce the overall ordering of the most common daily laboratory testing in our academic teaching service. We believe further research is needed to fully evaluate the effectiveness of other education forms on the redundant ordering of tests in the hospital setting.

  • cost awareness
  • daily laboratory testing
  • resident education

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  • Contributors All authors were involved in the quality improvement project and contributed to the writing of this manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.