"THINK" Before You Order: Multidisciplinary Initiative to Reduce Unnecessary Lab Testing

Unnecessary lab testing in hospitals can lead to patient harm, including anemia and sleep disruption. Prior research has shown that excessive testing is often driven by routine orders rather than clinical necessity. It was already known that such practices increase healthcare costs without improving outcomes. No prior work had resolved how to effectively reduce these orders in teaching hospitals. This gap motivated the development of interventions targeting clinician behavior. That uncertainty drove the need for multidisciplinary approaches combining education and system-level changes. Prior studies suggested that education alone is insufficient to change practice patterns. This paper introduces a novel nurse-driven protocol as a potential solution.

The aim of this study was to evaluate a student-led initiative to reduce unnecessary daily lab testing in a teaching hospital. The specific problem addressed was the overuse of routine lab orders despite guidelines. The motivation came from rising costs and patient safety concerns. The researchers proposed a multifaceted approach combining education and system changes. The intervention targeted clinicians, nurses, and hospital systems. The goal was to determine if a nurse-driven protocol could reduce testing frequency. The study also sought to estimate cost savings from reduced testing. The comparison to a control unit allowed for assessing the intervention’s specificity.

The study used a quasi-experimental interrupted time series design with segmented regression analysis. Data were collected over a 14-month period before and after the intervention. A control surgical unit was used for comparison to isolate the intervention’s effect. The intervention included clinician education, a publicity campaign, and gamification elements. A nurse-driven protocol was introduced to replace routine lab orders. The team implemented system-level changes to support the new protocol. The primary outcome was the rate of daily lab testing per patient day. Statistical analysis compared trends before and after the intervention.

The intervention led to a statistically significant decrease in daily lab testing. The postintervention effect estimate was -0.04 labs per patient day/month (p < .05). This decline was not observed in the control unit. The baseline trend showed increasing testing rates before the intervention. The control unit’s trend remained unchanged during the same period. The estimated monthly cost savings were $6,734. Over 14 months, total savings reached $94,269. The nurse-driven protocol was a key factor in reducing unnecessary orders. The combined approach of education and system changes proved effective.

The authors suggest that a multidisciplinary campaign can reduce unnecessary lab testing in teaching hospitals. The nurse-driven protocol was a central component of the intervention. The researchers propose that combining education with system-level changes is more effective than education alone. The control unit’s unchanged trend supports the intervention’s specificity. The cost savings demonstrate the economic benefits of the approach. The results suggest that student-led initiatives can contribute to quality improvement. The authors state that the approach is replicable in other hospital settings. The findings support the use of gamification and publicity to engage clinicians.