Daily laboratory investigations can persist despite clinical stability for a variety of reasons (e.g., daily order without a stop date, not reassessing whether investigations are still needed). Observational studies suggest that resident physicians order routine daily CBC (complete blood count) and electrolyte panels more frequently than attending physicians. Daily phlebotomy contributes to patient discomfort and iatrogenic anemia. Studies support the safe reduction of repetitive laboratory investigations when patients are clinically stable without a negative impact on patient outcomes, including readmission rates, critical care utilization, adverse events, or mortality. Laboratory investigations should be ordered with a specific purpose which directly links to a specific management plan for patients.
Sources: Choosing Wisely Canada. Canadian Association of Pathologists: Five Things Physicians and Patients Should Question [Internet]. 2014 Oct 29 [cited 2017 May 19].
Choosing Wisely Canada. Canadian Society of Internal Medicine: Five Things Physicians and Patients Should Question [Internet]. 2014 April 2 [cited 2017 May 19].
Ellenbogen MI, et al. Differences in routine laboratory ordering between a teaching service and a hospitalist service at a single academic medical center – a survey and retrospective data analysis. South Med J. 2017;110(1):25-30. PMID: 28052170.
Konger RL, et al. Reduction in unnecessary clinical laboratory testing through utilization management at a US Government Veterans Affairs Hospital. Am J Clin Pathol. 2016 Mar;145(3):355-64. PMID: 27124918.
Melendez-Rosado J, et al. Reducing unnecessary testing: an intervention to improve resident ordering practices. Postgrad Med J. 2017 Jan 19. pii: postgradmedj-2016-134513. PMID: 28104806.