The United States is responsible for 43% of lab expenditures worldwide, and up to 30% of lab tests may be unnecessary. 


This project aims to determine if a human “best practice alert (BPA)” could decrease the number of unnecessary labs ordered by residents at a major academic medical center. 

Description: Three internal medicine ward teams were randomized to the intervention, and two to the control group. Standing daily labs ordered for 3 or more days were recorded for every patient. A Quality Improvement resident visited intervention teams on four occasions, and asked if standing labs ordered 3 or more days could be decreased in frequency or discontinued. If a lab was not changed, the reason was recorded. 

Across both groups, 45% of patients had standing labs ordered for at least 3 days. In the intervention group, 32% of standing CBCs and 14% of BMPs were decreased in frequency and 28% and 20%, respectively, were discontinued. 7 to 47% of other chemistry tests were decreased or discontinued. Main reasons for not stopping labs include patient condition and consult request. 

Conclusions: Internal Medicine residents at this major academic medcal center decreased their daily lab ordering when prompted by another physician, offering evidence that an electronic medical record (EMR)-based BPA may be effective at reducing unnecessary lab tests. Next steps include developing an automated BPA and randomizing its use to test the efficacy.