Rounds Guideline Curbs Unnecessary Lab Tests

Unnecessary laboratory testing has been targeted by critics of US health care as an expensive and intrusive practice.

In an abstract presented at the 2015 American Thoracic Society annual meeting in Denver, CO, a team of New York City physicians reported on its efforts to improve quality of care by cutting back on testing in the medical intensive care unit of a city teaching hospital.

In the study they note that “unnecessary laboratory testing in the MICU contributes to anemia, patient discomfort, catheter infections, misguided therapy and increased costs” but that it is also promoted by MICU culture.

To see if they could change things, the team incorporated a new guideline in daily rounds.

They examined lab tests/patient days at baseline and after the intervention.

The researchers found that in their 12-bed ICU, during 103 patient days that they used as baseline the majority of patients had tests for liver function, magnesium, and phosphate. They found that from 30 to 75% of these tests were unnecessary, based on “criteria for appropriateness.”

They then developed guidelines that required that routine tests be limited to complete blood count and basic metabolic panel and that all other tests requires an indication. They further added a guideline that the decision on whether other lab tests were needed be decided in morning rounds.

After a pilot project, they instituted the new guidelines.

The results showed that the ICU teams accepted the change “with enthusiasm” and that there was a significant reduction in liver function tests (from 55% of patients during the baseline period to 15% after the intervention) coagulation tests (they dropped from 71% to 34%) magnesium (99% to 45%) and phosphate (99% to 35%).

There were no complications of cardiac arrhythmias or delay in procedures, they wrote.