Interventions to reduce repetitive ordering of low-value inpatient laboratory tests: a systematic review

Brandon Yeshoua, Chip Bowman, Jonathan Dullea, Jared Ditkowsky, Margaret Shyu, Hansen Lam, William Zhao, Joo Yeon Shin, Andrew Dunn, Surafel Tsega, Anne S. Linker, Manan Shah

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background Over-ordering of daily laboratory tests adversely affects patient care through hospital-acquired anaemia, patient discomfort, burden on front-line staff and unnecessary downstream testing. This remains a prevalent issue despite the 2013 Choosing Wisely recommendation to minimise unnecessary daily labs. We conducted a systematic review of the literature to identify interventions targeting unnecessary laboratory testing. Methods We systematically searched MEDLINE, EMBASE, Cochrane Central and SCOPUS databases to identify interventions focused on reducing daily complete blood count, complete metabolic panel and basic metabolic panel labs. We defined interventions as effective' if a statistically significant reduction was attained and highly effective' if a reduction of ≥25% was attained. Results The search yielded 5646 studies with 41 articles that met inclusion criteria. We grouped interventions into one or more categories: audit and feedback, cost display, education, electronic medical record (EMR) change, and policy change. Most interventions lasted less than a year and used a multipronged approach. All five strategies were effective in most studies with EMR change being the most commonly used independent strategy. EMR change and policy change were the strategies most frequently reported as effective. EMR change was the strategy most frequently reported as highly effective. Conclusion Our analysis identified five categories of interventions targeting daily laboratory testing. All categories were effective in most studies, with EMR change being most frequently highly effective. PROSPERO registration number CRD42021254076.

Original languageEnglish
Article numbere002128
JournalBMJ Open Quality
Issue number1
StatePublished - 23 Mar 2023


  • Audit and feedback
  • Hospital medicine
  • Laboratory medicine
  • Quality improvement


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