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Objectives: The aim of the study was to evaluate the essential and nonessential blood tests ordered on the internal medicine clinical teaching units (CTUs) at Kingston General Hospital. Our aim was to establish a baseline performance measure identifying appropriate use of laboratory tests that could be used to inform improvement over time.

Methods: For an 8-week period, 14 CTU attending physicians at Kingston General Hospital were surveyed. They were asked for each of their patients, "What blood tests do you consider to be essential for tomorrow morning to maintain appropriate care for this patient?" The following day, blood tests that were ordered were compared with the "essential" list previously given by the attending physicians.

Results: Of 291 processed blood tests, 148 (51%) had not been considered essential by attending physicians; of the 203 tests considered essential, 60 (30%) were not ordered. Total agreement between "essential" and processed tests was poor (κ = 0.51; confidence interval, 0.45-0.56).

Conclusions: Inadequate use of blood tests for CTU patients is common. Quality improvement initiatives should aim to address the lack of observed consensus between attending physicians' views and the ordered tests and to streamline decision-making and the ordering/communication processes. Clinical standards and guidelines regarding ordering of laboratory tests should be clearly defined.

Titel:	Essential and Nonessential Blood Testing in the Clinical Teaching Unit.
Autor/in / Beteiligte Person:	Sherren, C ; Day, A ; Ilan, R
Zeitschrift:	Journal of patient safety, Jg. 16 (2020-12-01), Heft 4, S. 307-309
Veröffentlichung:	Philadelphia, Pa. : Lippincott Williams & Wilkins, c2005-, 2020
Medientyp:	academicJournal
ISSN:	1549-8425 (electronic)
DOI:	10.1097/PTS.0000000000000363
Schlagwort:	Adolescent Adult Aged Aged, 80 and over Female Humans Male Middle Aged Surveys and Questionnaires Young Adult Hematologic Tests methods Internal Medicine education
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Journal Article; Research Support, Non-U.S. Gov't Language: English [J Patient Saf] 2020 Dec; Vol. 16 (4), pp. 307-309. MeSH Terms: Hematologic Tests / methods ; Internal Medicine / education ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Surveys and Questionnaires ; Young Adult References: Driskell OJ, Holland D, Hanna FW, et al. Inappropriate requesting of glycated hemoglobin (hb A1c) is widespread: assessment of prevalence, impact of national guidance, and practice-to-practice variability. Clin Chem. 2012;58:906–15. ; About the Campaign [Choosing Wisely web site]. Available at: http://www.choosingwisely.org. Accessed August 8, 2016. ; Thavendiranathan P, Bagai A, Ebidia A, et al. Do blood tests cause anemia in hospitalized patients? The effect of diagnostic phlebotomy on hemoglobin and hematocrit levels. J Gen Intern Med. 2005;20:520–4. ; Attali M, Barel Y, Somin M, et al. A cost-effective method for reducing the volume of laboratory tests in a university-associated teaching hospital. Mt Sinai J Med. 2006;73:787–94. ; Weydert JA, Nobbs ND, Feld R, et al. A simple, focused, computerized query to detect overutilization of laboratory tests. Arch Pathol Lab Med. 2005;129:1141–3. ; Mikhaeil M, Day A, Sun X, et al. Non-Essential Blood Testing in the ICU: An Observational Study. Toronto: Critical Care Canada Forum; 2014. ; Laxmisan A, Vaughan-Sarrazin M, Cram P. Repeated hemoglobin A1C ordering in the VA Health System. Am J Med. 2011;124:342–9. ; Ward ST, Gilbert S, Mulchandani M, et al. Unnecessary investigations in patients with acute pancreatitis: arterial blood sampling and serum biochemistry. Surgeon. 2008;6:282–7. ; Raad S, Elliott R, Dickerson E, et al. Reduction of laboratory utilization in the intensive care unit. J Intensive Care Med. 2016;pii: 0885066616651806. ; Verstappen WH, van der Weijden T, Sijbrandij J, et al. Effect of a practice-based strategy on test ordering performance of primary care physicians: a randomized trial. JAMA. 2003;289:2407–12. ; Signorelli H, Straseski JA, Genzen JR, et al. Benchmarking to identify practice variation in test ordering: a potential tool for utilization management. Lab Med. 2015;46:356–64. ; Zhi M, Ding EL, Theisen-Toupal J, et al. The landscape of inappropriate laboratory testing: a 15-year meta-analysis. PLoS One. 2013;8:e78962. Entry Date(s): Date Created: 20170224 Date Completed: 20210219 Latest Revision: 20210219 Update Code: 20240513

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Essential and Nonessential Blood Testing in the Clinical Teaching Unit.