Background: It is often assumed resident physicians at academic medical centers order more tests for inpatients due to different aspects of the clinical learning environment.  Despite this prevailing notion, there is very little evidence to support this claim. We sought to quantify differences in ordering practices between teaching hospitals and non-teaching hospitals for two common [...]

Background: It is often assumed resident physicians at academic medical centers order more tests for inpatients due to different aspects of the clinical learning environment.  Despite this prevailing notion, there is very little evidence to support this claim. We sought to quantify differences in ordering practices between teaching hospitals and non-teaching hospitals for two common [...]

Background: Laboratory testing is an integral part of modern medicine with an estimated 4-5 billion tests performed in the United States each year, and accounts for 3-5% of healthcare spending. At our resident-run clinic in an underserved community, the cost of laboratory tests in 2013 was over $400,000, exceeding the government subsidy. In this study, [...]

Background: Medical patients with comorbid psychiatric illness comprise 20-40% of general medicine inpatient admissions. These patients often have multiple providers involved in their care which can lead to poor communication, longer lengths of stay, and increased resource utilization. Despite substantial need, no standard model of care exists for this patient population. At our academic medical [...]

Background: Peripherally inserted peripheral catheter (PICC) use is associated with many complications including line related thromboembolism. Several studies and meta- analyses confirmed the increased risk to develop venous thromboembolism in non-O blood group patients. We wanted to assess the association between PICC line related thromboembolism and the ABO blood group. Methods: Our study sample consisted [...]

Background: Unnecessary diagnostic testing contributes to the escalating cost of health care in the US and can cause harm to patients. Daily blood work has become a routine part of care for hospitalized adults though only a fraction of tests change diagnosis or management decisions. At academic medical centers, residents are responsible for ordering most [...]

Background: The Choosing Wisely Campaign encourages physicians to avoid over-utilizing routine labs in hospitalized patients with clinical and laboratory stability.  A number of studies have shown adverse effects on hospitalized patients from lab overutilization.  In previous research, we observed that internal medicine physicians at our center often order a daily complete blood count (CBC) and [...]

Background: Misuse of laboratory tests can be difficult to determine unless tests are clearly overused or repeated routinely. However, excessive testing of chronically critically ill patients treated in long-term acute care hospitals (LTACHs) can be potentially harmful. A previously reported quality improvement initiative designed to increase physician awareness of their patterns of lab utilization in [...]

Background: The Choosing Wisely campaign was launched in 2012 with a goal of “advancing a national dialogue on avoiding wasteful or unnecessary medical tests, treatments, and procedures.[1] ”  The Society of Hospital Medicine published 5 recommendations for Adult Hospital Medicine in 2013[2] , including one that advised against performing repetitive complete blood count (CBC) and [...]

Background: As part of the ABIM Foundation’s Choosing Wisely campaign the Society of Hospital Medicine recommended providers avoid performing repetitive CBC and chemistry testing in the face of clinical and lab stability. In 2014 as part of an EMR upgrade our institution removed the “daily labs” order. A 1-year post change audit showed no change [...]