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Reducing the number of unnecessary routine laboratory tests through education of internal medicine residents
  1. Annum Faisal1,
  2. Kayla Andres1,
  3. Jubran Afzal Khan Rind1,
  4. Aparna Das1,
  5. David Alter2,
  6. Jeevarathna Subramanian3,
  7. Tracy J Koehler4,
  8. Jessica Parker5,
  9. Nathan Bernicchi5
  1. 1 Department of Internal Medicine, Spectrum Health-Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
  2. 2 Department of Pathology, Spectrum Health-Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
  3. 3 Department of Internal Medicine, UMass Memorial Health Care, Worcester, Massachusetts, USA
  4. 4 GME – Research, Spectrum Health, Grand Rapids, Michigan, USA
  5. 5 Spectrum Health Office of Research Administration, Grand Rapids, Michigan, USA
  1. Correspondence to Dr Annum Faisal, Department of Internal Medicine, Spectrum Health-Michigan State University College of Human Medicine, Grand Rapids, MI 49503, USA; annumfaisal{at}


Introduction The Choosing Wisely guidelines advise against ordering routine blood tests for hospitalised patients unless they change management. Unnecessary testing can lead to adverse effects (eg, iatrogenic anaemia, poor sleep quality, risk for infections and increased cost of care).

Methods An 8-week quality initiative aimed at reducing unnecessary blood tests was implemented in three internal medicine resident inpatient services. The initiative included a 30 min educational session, reminders prior to rotation and midrotation and posters in work areas that displayed lab pricing and urged judicious testing. Residents were encouraged to justify the purpose of ordering tests in their daily progress notes. Attending physicians were made aware of the initiative. Preintervention and postintervention time points were used to compare key metrics. A >10% decrease between time periods was used as an evaluation criterion.

Results There were 293 patient records reviewed in the preintervention period and 419 in the postintervention period. The two groups were similar in terms of age and gender. Median blood test count (complete blood count/basic metabolic profile/comprehensive metabolic profile) decreased from 4 to 2 tests per patient per day (50 % decrease) after the intervention. The median length of hospital stay decreased from 4.9 to 3.9 days (21% decrease). A decreased percentage of people requiring transfusions was also noted (2016: 6.1%, 2017: 2.9%).

Conclusion The frequency of unnecessary routine blood tests ordered in the hospital can be decreased by educating resident physicians, making them cost conscious and aware of the indications for ordering routine labs. Frequent reminders are needed to sustain the educational benefit.

  • graduate medical education
  • routine diagnostic tests
  • medical overuse
  • Anaemia
  • stay length

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  • Contributors AF contributed to the conception and design of the work, drafting the article and final approval of version to be published. KA contributed to the drafting of the article and its critical revision. JKAR and AD critically reviewed the article. JS, DA and TJK contributed to the conception and design, critical revision of this article and final approval of the version to be published. JP and NB contributed to data collection, its analysis and interpretation.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Spectrum Health IRB.

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