House Officer–Driven Reduction in Laboratory Utilization

OBJECTIVES: To determine whether sharing laboratory charge and personal utilization information with physicians can reduce laboratory test orders and expenditures, thereby decreasing the overutilization of laboratory testing. METHODS: This was a prospective study. By querying our electronic medical records, we calculated the median laboratory charges per patient/per day (PP/PD) and median laboratory tests ordered PP/PD for the resident general internal medicine and hospitalist services. For 10 weeks, we shared this team-based information with physicians with weekly updates. We calculated total laboratory charges for the 10 most common discharge diagnoses to capture laboratory charges for entire episodes of care. RESULTS: During the intervention, the mean number of laboratory tests ordered PP/PD by resident service decreased from 5. 56 to 5. 17 (-0. 389, P <0. 001) ; the mean charge PP/PD decreased from 488 to 461 (-27, P < 0. 001). The hospitalist service decreased the number of laboratory tests ordered PP/PD from 3. 54 to 3. 36 (-0. 18, P = 0. 77) and the mean charge PP/PD decreased from 331 to 301 (-30, P = 0. 96). The statistically significant decline in laboratory charges persisted after controlling for the 10 most common discharge diagnoses. Compared with the 3-month period before the study began, physicians in the 10-week intervention period ordered 1464 fewer laboratory tests, resulting in a 188, 000 reduction in charges and a 3% to 4% reduction in utilization. CONCLUSIONS: Informing physicians of the charges for laboratory tests and their personal utilization patterns can reduce the number of laboratory tests ordered and laboratory expenditures, especially for physicians in training.