Re-purposing the ordering of routine laboratory tests in hospitalized medical patients
Choosing Wisely Canada (CWC) and the Canadian Institute of Health Innovation (CIHI) estimate that Canadians receive over one million unnecessary laboratory tests each year. In the inpatient setting, low-value laboratory testing often occurs in the form of daily repetitive use of routine tests and is associated with hospital-acquired anemia, which may lead to increased blood transfusions, prolonged hospitalization, and higher mortality for patients.
PLP medical director Dr. Douglas Woodhouse and physician lead Dr. Anshula Ambasta developed and implemented virtual facilitated audit and group feedback sessions as one component of a multifaceted intervention bundle to reduce routine daily laboratory testing. The intervention bundle was implemented across eight medical units and four tertiary care hospitals in Calgary with an associated:
14% overall reduction of routine tests
Cost savings of $1.15 per patient day
20% increase in routine test-free patient days
No worsening in patient safety endpoints.
In March 2023, this multifaceted intervention is being scaled provincially through the Re-purposing the Ordering of Routine Laboratory Tests in Hospitalized Medical Patients (RePORT) project to 14 sites across Alberta. The PLP facilitated audit and feedback sessions aim to optimize laboratory testing by allowing physicians to reflect on their unit-level data and engage in peer discussions to identify barriers and facilitators to optimize test ordering practices.
This project supports the Choosing Wisely Canada recommendation to:
“In the inpatient setting, don’t order repeated CBC and chemistry testing in the face of clinical and lab stability”. (https://choosingwiselycanada.org/recommendation/internal-medicine/)