Controlling Unnecessary Laboratory Investigation Requests for Inpatients of General Internal Medicine
Keywords:
cost effective healthcare, internal medicine, quality improvement, patient safety, laboratory test overutilizationAbstract
Objective: To reduce unnecessary laboratory investigations by more than 15% over three months in the general internal medicine inpatient service at King Fahad Armed Forces Hospital (KFAFH), Jeddah, while maintaining patient safety and improving cost-effectiveness.
Methodology: A 12-week prospective interventional study was designed for January-March 2025, at KFAFH, Jeddah, Saudi Arabia. Patients admitted under internal medicine were included, while critically ill, surgical, or non-internal medicine admissions were excluded from analysis. A randomized sample of 200 patients was divided into two groups: 100 in the control group and 100 in the intervention group. For intervention groups, targeted education was provided to residents and registrars, with structured discussions during ward patient visit rounds, and the placement of visual reminders, including posters, banners, and images, in the clinical work area. The frequency of commonly requested laboratory investigations, including complete blood counts (CBCs), serum electrolytes, and liver function tests, was monitored throughout the study.
Results: A comparative analysis showed a statistically significant reduction in laboratory investigation requests in the intervention group compared with the control (p<0.0001).
This was further observed in the cost-effectiveness, with savings of SAR 86,600 per 100 patients. Interestingly, the reduction in the number of investigations did not affect patient outcomes, indicating that the quality and safety of care were maintained.
Conclusion: The study demonstrates that straightforward, multidisciplinary interventions can substantially reduce the overutilization of laboratory tests while providing cost-effective healthcare delivery, aligned with principles of high-value without compromising safety.
References
1. Keehan SP, Fiore JA, Poisal JA, Cuckler GA, Sisko AM, Smith SD et al. National Health Expenditure Projections, 2022-31: Growth To Stabilize Once The COVID-19 Public Health Emergency Ends. Health Aff. 2023 Jul 1; 42(7): 886–98.
2. Beriault DR, Gilmour JA, Hicks LK. Overutilization in laboratory medicine: tackling the problem with quality improvement science. Crit Rev Clin Lab Sci. 2021; 58(6): 430–46.
3. Salazar JH, Zahner CJ, Freeman VS, Laposata M. The Doctorate in Clinical Laboratory Sciences: A New Curriculum to Enhance the Connection of the Laboratory to Health Care Providers. Acad Pathol. 2021; 8.
4. Rudin RS, Thakore N, Mulligan KL, Ganguli I. Addressing the Drivers of Medical Test Overuse and Cascades: User-Centered Design to Improve Patient–Doctor Communication. Jt Comm J Qual Patient Saf. 2022; 48(4): 233–40.
5. Bates DW. What proportion of common diagnostic tests appear redundant? Am J Med. 1998; 104(4): 361–8.
6. Geleris JD, Shih G, Logio LS. Analyze Patient Tests for Importance before Ordering - Reply. JAMA Intern Med. 2019; 179(5): 730–1.
7. Hawkins A, Moynihan AM, Glassman K, Clarke S. Improving Compliance With Evidence-Based Laboratory Testing Recommendations and Monitoring Associated Patient Outcomes. AORN J. 2024; 120(2): e1–10.
8. Feldman LS, Shihab HM, Thiemann D, Yeh HC, Ardolino M, Mandell S et al. Impact of providing fee data on laboratory test ordering: A controlled clinical trial. JAMA Intern Med. 2013; 173(10): 903–8.
9. Muris DMJ, Molenaers M, Nguyen T, Bergmans PWMP, van Acker BAC, Krekels MME et al. Effect of a price display intervention on laboratory test ordering behavior of general practitioners. BMC Fam Pract. 2021; 22(1).
10. Martin C. The Price Is Right: Introducing Health Care Costs Through Gameful Learning. J Nurs Educ. 2022; 61(6): 352.
11. Moriates C. How can we finally reduce repetitive routine laboratory tests for hospitalized patients? BMJ Qual Saf. 2023; 32(9): 498–501.
12. Eaton KP, Levy K, Soong C, Pahwa AK, Petrilli C, Ziemba JB et al. Evidence-based guidelines to eliminate repetitive laboratory testing. JAMA Intern Med. 2017; 177(12): 1833–9.
13. Lacroix GA, Danford DA, Marshall AM. Impact of Phlebotomy Volume Knowledge on Provider Laboratory Ordering and Transfusion Practices in the Pediatric Cardiac ICU. Pediatr Crit Care Med. 2023; 24(7): E342–51.
14. Gürbüz M, Gencer G. Retrospective analysis of serologic test requests in the diagnosis of viral hepatitis: Inappropriate test requests and cost. Med (United States). 2024; 103(32): e39332.
15. Dadlez NM, Le Clair AM, Wasima S, Mayer N, Harvey WF, Roberts K et al. Preventing lost-to-follow up diagnostic imaging in ambulatory care: evaluation of an electronic notification tool. BMJ Open Qual. 2023; 12(3).
16. Dräger S, Giehl C, Søgaard KK, Egli A, de Roche M, Huber LC et al. Do we need blood culture stewardship programs? A quality control study and survey to assess the appropriateness of blood culture collection and the knowledge and attitudes among physicians in Swiss hospitals. Eur J Intern Med. 2022; 103: 50–6.
17. Dahm MR, Cattanach W, Williams M, Basseal JM, Gleason K, Crock C. Communication of Diagnostic Uncertainty in Primary Care and Its Impact on Patient Experience: an Integrative Systematic Review. J Gen Intern Med. 2023; 38(3): 738–54.
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