SHM Converge Scientific Abstract ePoster Gallery-Assessment of Appropriate Lab Utilization on a Hospital Medicine Service

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This study examined whether daily labs (DL) and labs ordered on the day of discharge (LOD) were being used appropriately for hospital medicine patients discharged to skilled nursing facilities (SNFs) at an urban academic tertiary medical center. The focus was on general medicine and cardiology patients, who were considered relatively stable while awaiting placement. Daily labs were defined as BMPs, CBCs, or both ordered every day of hospitalization.<br /><br />Five hospital medicine physicians reviewed cases using agreed-upon criteria to judge whether labs were appropriate. Labs were considered inappropriate when patients were clinically stable and daily monitoring was unlikely to change management. The study also compared ordering patterns between attending physicians and third-year internal medicine residents.<br /><br />Among 111 included encounters, 75% had daily labs and 75% had LOD labs ordered. Overall, 31% of daily labs and 39% of discharge-day labs were judged inappropriate. In attending-managed patients, 74% had daily labs and 76% had LOD labs ordered; in resident-managed patients, the rates were 77.5% and 75%, respectively. Rates of inappropriate ordering were similar between groups and were not statistically significant: 35% vs 26% for daily labs and 42% vs 33% for LOD labs.<br /><br />The study concluded that lab use in stable patients awaiting SNF discharge was high, with a substantial portion deemed unnecessary. It identified this population as a strong target for interventions to reduce lab overuse, lower costs, improve patient comfort, and limit harms such as iatrogenic anemia and sleep disruption.

Asset Subtitle

Rebecca L. Wilson

Meta Tag

Author List Ethan Molitch-HoU, Magdy El-Din MD, Matthew Cerasale, Rebecca L. Wilson, Shannon K. Martin

Category Research

Concept Laboratory Overuse

Concept Unnecessary Testing

Concept Daily Laboratory Test

Concept Discharge Laboratory Test

Concept Appropriateness Criteria

Distinguished Non-Finalist

Presenter Organization University of Chicago Section of Hospital Medicine

Presenting Author Rebecca L. Wilson

Track Quality Improvement

Keywords

daily labs

discharge-day labs

skilled nursing facilities

hospital medicine

lab overuse

inappropriate ordering

general medicine

cardiology patients

iatrogenic anemia

sleep disruption

Laboratory Overuse

Unnecessary Testing

Daily Laboratory Test

Discharge Laboratory Test

Appropriateness Criteria