WBB's Thought Leadership

Medically Unnecessary Tests Increase Costs and Safety Risks

January 9

Unnecessary medical tests raise the cost of care and introduce unnecessary patient safety risks. Surveys show that unnecessary tests are often ordered out of habit, or because staff overestimate the number of tests that attending physicians require.

Over half of respondents felt that attending physicians would be “uncomfortable” with reduced testing, while 37% stated that they order unnecessary tests to “satisfy attendings,” while 84% of attending physicians said they were comfortable with reduced testing for their patients.

WBB Take:  Medical tests are not trivial components of the delivery of medical care, and while they are typically indispensable to providing safe and effective care, they often carry significant costs and risks. Medically unnecessary testing wastes time that could be spent on other patients, wastes money and resources, and adds informational clutter to the clinical picture.
Unnecessary testing adds risks due to the test administration itself and because of the effect of clutter that may result in missed opportunities and medical errors. Many tests carry patient and clinician safety risks, such as physical injury, increased possibility of infection, and increased need for patient transportation and movement. The resulting increase in low-value information load adds little to the clinical picture, but adds significant bloat to the medical record. Bloated records drain clinician time, and increase clinician fatigue and burnout, and therefore raise the likelihood of missed opportunities and elevated risk of medical errors.

Cited by Matthew Loxton

Excerpt: “Unnecessary testing wastes money and can lead to further testing. Why does it occur? Almost 60% of medical personnel surveyed at a large academic medical center believed that hospitalized patients should have daily laboratory testing.”
“...Of note is that more than half of those who returned completed surveys said they thought attendings would be uncomfortable with less testing, and 37% said they ordered unnecessary tests to satisfy attendings. However, the category of respondents who least felt daily tests were needed was attending physicians at 28%, and 84% of attending physicians said they would be comfortable if their patients had fewer laboratory tests.”
“Unnecessary lab testing on their units was observed by 60% of respondents, but only 37% said they had requested unnecessary testing themselves. Perhaps the unnecessary tests had been ordered by people who did not respond to the survey or the tests were ordering themselves.”

The authors of the JAMA Internal Medicine study done at Memorial Sloan Kettering Cancer Center in New York, concluded that although nurses did not order laboratory testing themselves, they might have some effect on the frequency of lab tests being done. Another recent  survey published in Hospital Medicine asked internal medicine and general surgery residents at the Hospital of the University of Pennsylvania why they ordered unnecessary tests as defined by the authors.”

“Of the 116 respondents, 105 (90.5%) said they ordered daily labs out of habit because that’s the way they were trained. Other frequent responses were that tests were ordered because residents weren’t aware of the costs (86.2%), discomfort with diagnostic uncertainty (82.8%), and as was the case in the previous paper, concern that the attending would ask for the lab results (75.9%).”
“Solutions offered by the residents surveyed included making the residents aware of the  costs, improving faculty role modeling [in other words, educating the attending physicians], computerized reminders/decision support, and educating the staff.”
“An October 2017 review of the literature on this subject offered a lengthy algorithm for eliminating unnecessary and repetitive testing—including education, auditing orders, giving feedback to staff, and allowing the electronic medical record to prohibit or limit repeat orders.”

Source: Physicians Weekly

 


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