Evaluating resident perceptions on inappropriate inpatient laboratory testing

Opportunity

Patients have blood drawn almost every day during a typical hospital stay. Lab tests are among the most common orders placed by physicians, but nearly one-third of these tests are not needed. Residents are on the frontlines of care and are suited to reveal why inappropriate lab test ordering occurs.

Approach

We conducted a survey of internal medicine and general surgery residents at Penn Medicine. We asked them how often they ordered inappropriate tests and the reasons for these behaviors. We also asked them to propose strategies to reduce inappropriate ordering.

Impact

More than 80 percent of residents stated that they ordered unnecessary tests, and nearly 50 percent of them said they did so daily. Residents attributed this behavior to health system culture, a lack of transparency around the cost of tests, and a lack of faculty role models who celebrate restraint. The most commonly proposed solutions were increasing price transparency and improving faculty modeling of cost-conscious behaviors.