Evidence map›Paper›PMID 36958791›Full record

SynthesisBMJ open quality2023

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 and 2 more

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ open quality, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers.

0numbers the graph read from it
0cells of the map it votes in
22citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

22 citing papers in PubMed.

  1. Article
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  5. Review
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  16. Observational
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Brandon Yeshoua *Icahn School of Medicine, Mount Sinai, New York, New York, USA brandon.yeshoua@icahn.mssm.edu.ORCID 0000-0001-8555-3509
Chip Bowman *Department of Medicine, Mount Sinai, New York, New York, USA.
Jonathan DulleaIcahn School of Medicine, Mount Sinai, New York, New York, USA.
Jared DitkowskyEmergency Medicine, Hackensack Meridian Hackensack University Medical Center, Hackensack, New Jersey, USA.
Margaret ShyuDepartment of Medicine, Mount Sinai, New York, New York, USA.
Hansen LamDepartment of Pathology and Laboratory Medicine, Icahn School of Medicine at Mount Sinai Lillian and Henry M Stratton-Hans Popper, New York, New York, USA.
William ZhaoIcahn School of Medicine, Mount Sinai, New York, New York, USA.
Joo Yeon ShinIcahn School of Medicine, Mount Sinai, New York, New York, USA.
Andrew DunnHospital Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Surafel TsegaDepartment of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Anne S LinkerDepartment of Medicine, Mount Sinai, New York, New York, USA.
Manan ShahDepartment of Medicine, Mount Sinai, New York, New York, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundOver-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.

methodsWe 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.

resultsThe 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.

conclusionOur 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.

Indexed as

Clinical Laboratory TechniquesUnnecessary ProceduresHumansInpatientsAudit and feedbackCOST-EFFECTIVENESSHospital medicineLaboratory medicineQuality improvement

Identifiers

PMID36958791
PMCPMC10040017

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.