A multicentric intervention based on nudging for the reduction of potentially unnecessary laboratory tests: insights from a Swiss hospital network.

backgroundHealthcare overuse is a widespread issue, accounting for approximately 10–30% of total healthcare costs. This study examines the impact of a computerized alert system designed to reduce inappropriate laboratory tests across five public hospitals in southern Switzerland.

methodsA 32-month observational study - between July 2021 and March 2024 - was conducted to assess the effectiveness of the alert system in discouraging unnecessary laboratory testing. Data were collected from five public hospitals where 12.4% of laboratory tests performed were identified as non-compliant with recommended minimal retesting intervals (MRI). Of these non-compliant tests, 11.4% were prevented by the alert system, indicating direct intervention efficacy.

resultsDistinct patterns in alert acceptance rates emerged over time. Hospital H4 showed a significant increase in alert acceptance, which may reflect contextual factors such as a work environment promoting open communication and kindness among healthcare professionals. Conversely, hospitals H1 and H5 experienced declining alert acceptance, likely due to habituation effects. A learning effect was suggested by a significant reduction in inappropriate tests for certain markers, such as C-Reactive Protein (CRP), over time. Following the alert’s implementation, the average rate of appropriate prescriptions across all hospitals was 87.5%. Specific tests, including PSA (19.4%), PTH (15.5%), ammonia (14.8%), and CRP (14.5%), had higher alert acceptance rates. The cost savings from avoided tests were estimated at EUR 1,642,417.

conclusionsThis study confirms that computerized alerts represent a gentle, effective and cost-efficient method to reducing overtreatment, increasing awareness among healthcare professionals, and supporting personalized medicine. The findings suggest: hypothetically - that organizational environments fostering human-centered care, effective communication and kindness may enhance the impact of alert systems, warranting further empirical investigation. WHAT IS KNOWN ON THIS TOPIC: Overmedicalization accounts for 10–30% of healthcare costs, representing a significant concern in health resource management. The Minimum Repeat Interval (MRI) defines appropriate time at which a laboratory test can be repeated to minimize potentially unnecessary ones. Alerts in computerized medical records, indicating tests prescribed within the MRI, can effectively reduce unnecessary testing, especially when combined with other interventions. WHAT THIS STUDY ADDS: This study demonstrates that laboratory alerts based on MRI effectively reduce overtreatment, enhancing personalized medicine, with unique data from 929,808 tests over 32 months. Alert compliance and appropriateness vary by test type, showing greater effectiveness for tests with higher risk of being inappropriately prescribed (e.g. CRP). Hypotheses are proposed regarding the potential influence of organizational culture - particularly environments promoting kindness - on the effectiveness of behavioral nudges.