As part of the Choosing Wisely® campaign, the Society of Hospital Medicine recommends against performing “repetitive complete blood count chemistry testing in the face of clinical and lab stability.” With this recommendation as a framework, we targeted 2 hospitalist-run inpatient medicine units that employed bedside, scripted, interdisciplinary rounds. Our multifaceted intervention included prompting the hospitalist to identify clinically stable patients for next-day discharge and to discontinue labs when appropriate. It was coupled with the education of the clinicians and a regular data review for the hospitalists and unit staff. Among 2877 discharges included in a 1-year period, there was a significantly decreasing trend after the intervention in the percentage of patients getting labs in the 24, 48, and 72 hours before discharge (−1.87%, −1.47%, and −0.74% decrease per month, respectively; P less than 0.05). Our structured, multifaceted approach effectively reduced daily lab testing in the 24 to 48 hours prior to discharge.
Though statistically significant the magnitude of success was not what I would call robust.