Less testing, more yield: a multicomponent intervention halves inpatient biochemistry

Routine inpatient biochemical testing is often repeated without clinical indication. This quality improvement project aimed to reduce low-value biochemical testing in a Danish cardiology ward, targeting a 5% reduction within 6 months and sustainment for 12 months, without adverse changes in length of stay, discharges after noon, or 30-day readmissions.

In a quality improvement project using the Model for Improvement and conducted through Plan-Do-Study-Act cycles, a multidisciplinary team implemented the following interventions: (i)targeted education for physicians and nurses e.g. clarifying of ordering responsibility; (ii)refinement of default biochemical profiles by removing non-essential tests (e.g. leukocyte count with differential, urea, hemoglobin) and curbing premature orders placed before the minimum re-testing interval; and (III)a centrally placed feedback dashboard. The primary outcome was the number of biochemical tests, adjusted for hours of hospitalization and caseload. Secondary outcomes were the proportion of results outside reference intervals and re‑testing intervals for common biochemical tests. Safety balancing measures were length of stay, discharges after noon, and 30-day readmissions. The pre-intervention period ran from February 27th, 2022, to February 26th, 2023, post-intervention period from March 5th, 2023, to February 2nd, 2025.

After biochemical profile refinement in June 2023, median number of biochemical tests decreased 54% (hours of hospitalization adjusted) and 48% (caseload adjusted). The proportion of test results outside reference ranges increased 21%. Re-testing intervals lengthened for hemoglobin and troponin-I. Balancing measures showed no adverse signals, and effects persisted into February 2025.

A pragmatic, simple bundle halved routine biochemical tests and increased diagnostic yield without measurable harm.