Changing resident test ordering behavior: a multilevel intervention to decrease laboratory utilization at an academic medical center

Am J Med Qual. Jan-Feb 2015;30(1):81-7. doi: 10.1177/1062860613517502. Epub 2014 Jan 17.


Hospital laboratory test volume is increasing, and overutilization contributes to errors and costs. Efforts to reduce laboratory utilization have targeted aspects of ordering behavior, but few have utilized a multilevel collaborative approach. The study team partnered with residents to reduce unnecessary laboratory tests and associated costs through multilevel interventions across the academic medical center. The study team selected laboratory tests for intervention based on cost, volume, and ordering frequency (complete blood count [CBC] and CBC with differential, common electrolytes, blood enzymes, and liver function tests). Interventions were designed collaboratively with residents and targeted components of ordering behavior, including system changes, teaching, social marketing, academic detailing, financial incentives, and audit/feedback. Laboratory ordering was reduced by 8% cumulatively over 3 years, saving $2 019 000. By involving residents at every stage of the intervention and targeting multiple levels simultaneously, laboratory utilization was reduced and cost savings were sustained over 3 years.

Keywords: cost; laboratory utilization; quality improvement; resident engagement.

MeSH terms

  • Academic Medical Centers / economics
  • Academic Medical Centers / organization & administration*
  • Cooperative Behavior
  • Cost Savings
  • Feedback
  • Humans
  • Inservice Training
  • Internship and Residency / organization & administration*
  • Laboratories, Hospital / economics
  • Laboratories, Hospital / statistics & numerical data*
  • Practice Patterns, Physicians' / economics
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Reimbursement, Incentive
  • Social Marketing
  • Unnecessary Procedures*