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Choosing Daily Labs Wisely in the Hospital: A Novel Tool for Assessing Laboratory Testing Appropriateness
Caleb J Murphy1, Alisa M Duran, Susan J Diem
1Department of Medicine, University of Nevada-Las Vegas School of Medicine (Dr Murphy); Section of Women's Health (Dr Duran) and General Internal Medicine (Drs Diem and Bowman Peterson), Minneapolis VA Healthcare System, Minneapolis, Minnesota; and Department of Medicine, University of Minnesota Medical School, Minneapolis (Drs Duran, Diem, and Bowman Peterson).
Background:
The Minnesota Lab Appropriateness (MLAB) criteria were developed for assessing appropriateness of complete blood counts (CBCs) and serum electrolyte panels (SEPs) ordered for adult inpatients.
Methods:
Two independent raters used the MLAB criteria to rate appropriateness of labs ordered during 50 hospitalizations through retrospective medical record review.
Results:
Evaluation of 208 CBCs and 253 SEPs on a 2-category scale (appropriate/inappropriate) resulted in an inappropriate lab rate of 24% and 25% for CBCs and SEPs, respectively. Using a 3-category Likert scale that included an "equivocal" rating to allow for clinical uncertainty, 17% of CBCs and 20% of SEPs were considered inappropriate. Interrater reliability was "substantial" using the dichotomous scale for both CBCs and SEPs. Using the 3-category Likert scale, reliability was "substantial" for CBCs and "moderate" for SEPs.
Conclusion:
The MLAB criteria identified inappropriate labs at a rate consistent with published figures, with good interrater reliability.
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Preparation:

