Evaluating resident perceptions on inappropriate inpatient laboratory testing

Opportunity

Patients are stuck for a blood draw almost every day they are admitted to a hospital. Lab tests are one of 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 suited to reveal insights into 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% of residents stated that they ordered unnecessary tests and nearly 50% of them stated they did so on a daily basis. Residents attributed this behavior to health system culture, a lack of transparency around the cost of tests, and a lack of faculty role models that celebrate restraint. The most commonly proposed solutions were increasing price transparency and improving faculty modeling of cost-conscious behaviors. 

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