Background: Bronchiolitis is a clinical diagnosis, with growing research supporting limited use of diagnostic tests and interventions. Hospitals have reduced use of bronchodilators and imaging, but the national average of respiratory viral testing (RVT) in these children continues to be high at 33%. Over the past three years, RCHSD’s rate has persisted at 31-35%, despite [...]

Background: Thrombophilia testing is frequently ordered in the inpatient setting. However, testing is costly and can be misleading in the setting of acute thromboembolism or concurrent anticoagulation use. Furthermore, hereditary thrombophilias do not predict a clinically significant increase in VTE recurrence. Methods: We conducted an educational intervention with a randomized cross-over design for Internal Medicine [...]

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: The Centers for Disease Control and Prevention (CDC) estimates over 1.2 million Americans are living with HIV (human immunodeficiency virus). Of those, approximately 14% are unaware of their HIV-positive status. In 2014, most hospitals adopted some form of Electronic Health Records (EHR) and one year later, the Centers for Medicare & Medicaid Services extended [...]

Background: Previous studies have determined that a small subset (~10%) of the results of tests pending at discharge (TPADs) require action. Challenges for hospitalists in dealing with actionable TPADs include identifying TPADs that are truly actionable and ensuring appropriate follow-up. Little is known about the factors that predict whether a TPAD is actionable. The goal [...]

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: 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 [...]