425 Understanding Drivers of Laboratory Test Overuse in Clinical Practice: A Strategy for Enhancing Financial Wellbeing at USA Health University Hospital

Introduction/Objective Laboratory testing is foundational to modern clinical decision-making. However, overutilization of certain tests can lead to unnecessary healthcare expenditures, increased patient burden, and inefficient resource use. At USA Health University Hospital, prolonged turnaround time and test overuse in the Chemistry Section were identified as key operational challenges. This study aims to characterize the drivers of test overuse and evaluate contributing system-level and behavioral factors influencing physician ordering patterns. Methods/Case Report We conducted a mixed-methods quality improvement project comprising both quantitative and qualitative components. As a quantitative component, 12 months of EHR data were requested to identify high-frequency and potentially redundant chemistry tests. Utilization was benchmarked against published evidence-based guidelines to flag low-value testing. This element of the study is ongoing. As the qualitative component, a 15-question anonymous electronic survey (Qualtrics) was distributed to physicians across internal medicine, emergency medicine, and surgical departments. Questions assessed knowledge of test costs, understanding of appropriateness guidelines, attitudes toward defensive medicine, use of order sets, and openness to feedback. Results Fourteen clinicians participated, including residents (43%), attendings (36%), and fellows (14%). Pathology (29%), orthopedic surgery (14%), and gastroenterology (14%) were the most represented specialties. About 43% had less than one year of post-residency experience. While 71% were only somewhat familiar with test ordering guidelines, 50% were very confident their orders were clinically appropriate. Only 14% always considered test cost. Diagnostic uncertainty (43%) and EHR defaults were key drivers of overuse. Fifty-seven percent believed test overuse is a problem; 71% felt EHR order sets might contribute to it. Feedback on ordering patterns was supported by 64% of respondents. Preferred interventions included peer discussion (mean 4.08/6) and feedback reports (3.54/6). Qualitative responses revealed recurring themes: EMR design issues (e.g., redundant order sets, difficulty viewing active orders), fear of litigation, pressure from consulting services, and expectations tied to specific complaints. Some noted result delays led to ordering alternative tests prematurely. Sixty-two percent felt test overuse compromises patient safety. Nearly half (46%) reported ordering fewer tests now than during training, citing increased confidence, improved guideline knowledge, and narrower clinical focus. Others mentioned inconsistent expectations from attendings and variability in EMR workflows as persistent challenges to ordering restraints. Conclusion Laboratory test overuse at our institution stems from both cognitive and system-level factors. Interventions targeting EHR design, test cost visibility, and provider education may effectively reduce low-value test utilization. Enhancing laboratory stewardship is critical not only for financial sustainability but also for promoting high-value patient care.