Background: Excessive daily routine laboratory testing for hospitalized patients is a contributor to poor hospital sleep, iatrogenic anemia, and excessive costs. Recommendations from the Choosing Wisely™ campaign specifically state to avoid sleep interruptions for routine care (American Academy of Nursing) and to avoid routine labs for stable patients (Society of Hospital Medicine). The purpose of [...]

Background: Sleep is generally poor in hospitalized patients and sleep deprivation has many harmful effects, including delirium, insulin resistance, hypertension, and impaired function of the immune system. In this quality improvement (QI) project, our goal was to delay early morning phlebotomy blood collections to improve sleep for our patients, while not negatively impacting hospitalists’ perception [...]

Background:   In line with the American Board of Internal Medicine’s (ABIM) Choosing Wisely® initiative, the Society of Hospital Medicine (SHM) recommends not performing repetitive complete blood count (CBC) and chemistry (CHEM7) testing in the face of clinical and lab stability.  In addition to decreasing the risk of hospital acquired anemia (HAA), reducing unnecessary routine blood work can ultimately result in significant [...]

Background: Inpatient phlebotomy-associated-anemia (PAA) has garnered significant attention in recent years, with numerous studies delving into this common and preventable condition’s implications for patient outcomes. During hospitalization, it is estimated that about 18% of patients develop anemia associated with phlebotomy. We evaluated the prevalence and impact of PAA at Grady Memorial, a public safety-net hospital. [...]

Background: On inpatient general medicine units, the timing of routine lab draws is not evidence-based, and common practice is for routine labs to be collected in the early morning. However, this collection time may not be optimal for patient satisfaction, nursing and physician workflow, and the overall efficiency of care. It is known that early [...]

Background: The Society of Hospital Medicine (SHM) identifies repetitive CBC & chemistry testing as low-value, and they selected this as a Choosing Wisely Recommendation. Overuse of phlebotomy is associated with hospital-acquired anemia, decreased patient satisfaction and increased hospital costs. Process improvement techniques have been utilized to reduce inpatient phlebotomy, but prospectively identifying a cohort of [...]

Background: The ABIM’s Choosing Wisely campaign targets daily phlebotomy in medical inpatients as an area of potential wasteful care.  Unnecessary phlebotomy increases labor and costs while negatively impacting patient’s through hospital-acquired anemia, intravenous access issues, and false-positive results.  While previous interventions have attempted to reduce overall labs ordered, few studies have examined educational attempts  to reduce unnecessary lab [...]

Background: Up to 50% of the American healthcare spending is estimated to be wasteful. The largest type of wasteful spending is on overuse of tests and treatments. Among the diagnostic tests that are overused, excessive phlebotomy stands out due to its multifaceted implications, including hospital-acquired anemia, patient discomfort, provider burden, and avoidable downstream testing. The [...]

Case Presentation: A 73-year-old male with a past medical history of hypertension, benign prostatic hypertrophy, gastroesophageal reflux disorder, latent tuberculosis, and no smoking history presented with 4 days of chills, dyspnea, diarrhea, and dysuria. Initial vital signs were notable for SpO2 88% on room air and HR 110s. Labs were notable for VBG with slight [...]