"tHINK" before You Order: Multidisciplinary Initiative to Reduce Unnecessary Lab Testing

Masih Shinwa, Adam Bossert, Iris Chen, Anna Cushing, Andrew S. Dunn, Jashvant Poeran, Sally Weinstein, Hyung J. Cho

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Inappropriate daily lab testing can have adverse effects on patients, including anemia, pain, and interruption of sleep. We implemented a student-led, multifaceted intervention featuring clinician education, publicity campaign, gamification, and system changes, including a novel nurse-driven protocol to reduce unnecessary daily lab testing in a teaching hospital. We applied a quasi-experimental interrupted time series design with a segmented regression analysis to estimate changes before and after our 14-month intervention with a comparison to a control surgical unit. There was an increasing trend in the baseline period, which was mitigated by the intervention (postintervention effect estimate-0.04 labs per patient day/month, p <.05), which was not seen in the control unit. Estimated cost savings was $94,269 ($6,734/month). A student-led, multidisciplinary campaign involving nurse-driven pathway, education, publicity, gamification, and system changes was effective in reducing daily lab testing.

Original languageEnglish
Pages (from-to)165-171
Number of pages7
JournalJournal for healthcare quality : official publication of the National Association for Healthcare Quality
Issue number3
StatePublished - 1 May 2019


  • choosing wisely
  • high value
  • quality improvement
  • utilization


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