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: Routine laboratory testing is a cornerstone of inpatient care. However, indiscriminate ordering can lead to resource waste, prolonged length of stay, and unnecessary costs. At our community teaching hospital in Queens, New York, we identified high rates of vitamin level testing—specifically vitamin B12, folate, and vitamin D25—which were often ordered without clinical indication. This [...]

Background: Literature on the prognostic value of laboratory tests on patients hospitalized with COVID-19 is sparse.1-4 Based on available evidence our institution developed a protocol for care of patients admitted with COVID-19. In addition to routine labs (complete blood count, complete metabolic panel, venous lactate, etc.), the protocol recommends a set of COVID-specific daily lab [...]

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: Frailty is a clinical syndrome characterized by vulnerability to stressors resulting from a loss of physiological reserve across multiple systems. Frailty is a common condition in older adults and is associated with disability, morbidity, increased healthcare utilization, and mortality. Frailty assessments derive from two major frameworks: the frailty phenotype and the deficit accumulation model. [...]

Background: Thoughtful laboratory testing is a key component of high-value and cost-effective patient care. Studies estimate that nearly half of laboratory tests may be unnecessary in certain patient populations. The drivers of observed variation in laboratory testing are not clearly established; our study aims to examine whether testing varies by hospitalist years of experience. Methods: [...]

Background: Failure to follow-up results of laboratory tests pending at discharge (TPADs) can lead to patient harm. Numerous interventions have been proposed to improve follow-up. The Laboratory Medicine Best Practices (LMBP™) workgroup, sponsored by the Centers for Disease Control, commissioned a systematic review to address the impact of various interventions on TPAD documentation, communication, and [...]

Background:  Healthcare delivery has become more expensive, with a portion of the elevated cost due to increased utilization of laboratory studies. The Choosing Wisely campaign is an initiative of the American Board of Internal Medicine Foundation focused on preventing wasteful care. Accordingly, the Critical Care Societies Collaborative developed an evidence-based list describing overutilization practices.  This [...]

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 ordering of unnecessary daily labs affects the safety of patients through hospital-acquired anemia, patient discomfort, and unnecessary downstream testing. This results in both additional financial and labor costs burdening the health system. As such, establishing effective interventions is warranted with necessary analysis of site-specific lab-ordering culture. We seek to perform this analysis to [...]