Department of Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.
JAMA Intern Med. 2017 Dec 1;177(12):1833-1839. doi: 10.1001/jamainternmed.2017.5152.
Routine daily laboratory testing of hospitalized patients reflects a wasteful clinical practice that threatens the value of health care. Choosing Wisely initiatives from numerous professional societies have identified repetitive laboratory testing in the face of clinical stability as low value care. Although laboratory expenditure often represents less than 5% of most hospital budgets, the impact is far-reaching given that laboratory tests influence nearly 60% to 70% of all medical decisions. Excessive phlebotomy can lead to hospital-acquired anemia, increased costs, and unnecessary downstream testing and procedures. Efforts to reduce the frequency of laboratory orders can improve patient satisfaction and reduce cost without negatively affecting patient outcomes. To date, numerous interventions have been deployed across multiple institutions without a standardized approach. Health care professionals and administrative leaders should carefully strategize and optimize efforts to reduce daily laboratory testing. This review presents an evidence-based implementation blueprint to guide teams aimed at improving appropriate routine laboratory testing among hospitalized patients.
对住院患者进行日常实验室检测反映了一种浪费的临床实践，这种实践威胁着医疗保健的价值。许多专业协会的明智选择倡议已经确定，在临床稳定的情况下重复进行实验室检测是低价值的护理。尽管实验室支出通常不到大多数医院预算的 5%，但鉴于实验室检测几乎影响所有医疗决策的 60%至 70%，其影响范围非常广泛。过度采血可能导致医院获得性贫血、增加成本以及不必要的下游检测和程序。减少实验室订单的频率的努力可以提高患者满意度并降低成本，而不会对患者的结果产生负面影响。迄今为止，许多干预措施已经在多个机构中部署，而没有采用标准化的方法。医疗保健专业人员和行政领导应该仔细制定策略，并优化减少日常实验室检测的工作。本综述提供了一个基于证据的实施蓝图，以指导旨在改善住院患者常规实验室检测的团队。
