The routine inpatient tests most often ordered without need

Design

Process evaluation of a national quality improvement collaborative

Population

157 Canadian hospitals, 2021–2026

Primary outcome

Engagement and interventions used to reduce low-value testing

Effect

78% of interventions were multimodal; urea, AST and coagulation tests most targeted

Choosing Wisely Canada's Using Labs Wisely collaborative has grown to 157 hospitals since 2021. This process evaluation describes how it works rather than measuring patient outcomes.

The collaborative tracks eight low-value inpatient tests: coagulation profiles, AST, urea, CK-MB, folate, vitamin B12, ESR and urine cultures. Urea, AST and coagulation tests were the ones hospitals most often targeted. Most successful programmes (78%) combined several methods: education, audit and feedback, changes to order sets and ordering rules.

The list is a useful check for any medical ward. Each test on it is often repeated daily out of habit rather than because the result will change management.

• Avoid ordering coagulation profiles routinely in patients not on anticoagulants or with liver disease.
• Consider dropping AST from routine liver monitoring when ALT is already measured.
• Stop daily repeat urea when creatinine and electrolytes answer the question.
• Send urine cultures only when there are symptoms of urinary infection.
• Combine teaching with order-set changes; single measures rarely last.

Why it matters

Unnecessary tests cause anaemia, false alarms and cost; the commonest culprits are now named.

Don't overread it

This report describes the programme; it does not show patient outcomes improved.

Read the rest in the app

You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.

Get Daily Doctor — free

Scan to keep reading on your phone. No account needed to start.