Housestaff Barriers to the Reduction of Daily Laboratory Testing in a Large Academic Center

From the 2018 HVPAA National Conference

Kevin Eaton (Johns Hopkins School of Medicine), Amit Pahwa (Johns Hopkins School of Medicine)


Professional societies recommend reducing repetitive lab testing on clinically stable patients. Daily lab orders remain a significant contributor to unnecessary lab testing.


In our large academic medical center, resident physicians order the majority of lab tests since they are the primary providers for hospitalized patients. Understanding the perceived barriers of resident physicians to reducing daily lab orders will help target future interventions to reduce repetitive testing.


We conducted a qualitative analysis of perceived resident ordering practices in the Department of Medicine at a large academic center. A survey was created to identify cultural and workflow barriers to reducing lab testing. All levels of resident training were asked to participate in the survey. The survey was anonymous and voluntary.


There was a 54% response rate (n=81) of Internal Medicine residents at all levels of training. Among respondents, 87.7% reported ordering repeating daily labs on over 75% of their patients on admission. The majority of respondents reconsidered the need for daily labs on less than half their patients. Reasons reported for ordering daily labs included making it easier for co-residents, expected from senior residents, and needed for patient’s clinical care.


Understanding the workflow practices and barriers of ordering providers is important for building a sustainable approach to laboratory reduction. Future interventions to target these barriers can help reduce daily laboratory testing.

Implications for the Patient

The reduction of daily laboratory testing can improve the value of care delivered to hospitalized patients.