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J Hosp Med. 2016 Dec;11(12):869-872. doi: 10.1002/jhm.2645. Epub 2016 Aug 13.

Residents' self-report on why they order perceived unnecessary inpatient laboratory tests.

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Department of Medical Oncology, Therapeutics Research, City of Hope, Duarte, California.
Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
Crescenz VA Medical Center, Philadelphia, Pennsylvania.
Department of Urology, John Hopkins Hospital, Baltimore, Maryland.
Department of Vascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.


Resident physicians routinely order unnecessary inpatient laboratory tests. As hospitalists face growing pressures to reduce low-value services, understanding the factors that drive residents' laboratory ordering can help steer resident training in high-value care. We conducted a qualitative analysis of internal medicine (IM) and general surgery (GS) residents at a large academic medical center to describe the frequency of perceived unnecessary ordering of inpatient laboratory tests, factors contributing to that behavior, and potential interventions to change it. The sample comprised 57.0% of IM and 54.4% of GS residents. Among respondents, perceived unnecessary inpatient laboratory test ordering was self-reported by 88.2% of IM and 67.7% of GS residents, occurring on a daily basis by 43.5% and 32.3% of responding IM and GS residents, respectively. Across both specialties, residents attributed their behaviors to the health system culture, lack of transparency of the costs associated with health care services, and lack of faculty role models that celebrate restraint. Journal of Hospital Medicine 2015;11:869-872.

[Indexed for MEDLINE]

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