[Streamlining laboratory tests in an internal medicine department: Economic and environmental benefits]

The overuse of laboratory tests in hospitals contributes to increased healthcare costs and a larger environmental footprint. This study aimed to evaluate the impact of a rational laboratory test-ordering strategy in an internal medicine department.

We conducted a prospective, single-center study in an internal medicine department. The study consisted of a baseline phase without intervention followed by an intervention phase during which internal guidelines promoting rational test ordering were implemented and supervised. The primary outcomes were changes in the volume and cost of the most frequently ordered laboratory tests. Secondary outcomes included hospital activity indicators and morbidity and mortality data.

A total of 1,816 patients were admitted for inpatient care between November 2023 and April 2024. Following implementation of the rational prescribing strategy, the volume of orders significantly decreased for the ten targeted laboratory tests (complete blood count, C-reactive protein, vitamins B9 and B12, lipid panel, serum protein electrophoresis, HbA1c, vitamin D, B-type natriuretic peptide [BNP], and thyroid-stimulating hormone [TSH]), with reductions ranging from 33% to 69%. The overall cost of these tests decreased by €11,334 over three months. No significant differences were observed between the two periods in terms of number of admissions, mean length of stay, transfers to intensive care, or in-hospital mortality.

Implementing a rational laboratory test-ordering strategy in an internal medicine department significantly reduced the volume and cost of testing without adversely affecting hospital activity indicators or morbidity and mortality outcomes. This simple, reproducible, and well-accepted approach represents a practical opportunity for clinical, economic, and environmental optimization.