Using Labs Wisely is a Choosing Wisely Canada collaborative of 157 hospitals, described in the Journal of Hospital Medicine on 5 October. It tracks eight low-value inpatient tests, benchmarks hospitals against each other, and shares improvement projects.
The eight tests are coagulation profiles, AST, urea, CK-MB, folate, vitamin B12, ESR and urine cultures. Urea, AST and coagulation profiles were the tests hospitals worked on most. Most interventions used several methods together: education, audit and feedback, changes to order sets and ordering rules.
This paper describes engagement rather than measuring harm prevented, so it is evidence of what is feasible, not of outcomes. But the case against these tests is long established: repeated daily bloods cause iatrogenic anaemia, sleep disruption, incidental findings and cost, without changing management.
The ward change is simple. Order each test for a reason, and stop standing orders for daily panels that no one reads.
- Replace standing daily blood panels with tests ordered for a specific question.
- Do not add AST to every liver panel when ALT is already measured, unless there is a reason.
- Avoid routine clotting screens in patients not on anticoagulants or bleeding.
- Do not send urine cultures from asymptomatic catheterised patients.
- Use troponin, not CK-MB, for myocardial injury.
Why it matters
Low-value testing is one of the few hospital harms a single physician can remove on the next round.
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