Cost of Routine Daily Hospital Labs.

What is the cost of routine daily hospital labs?  About $275 at one institution.  This is a big issue for hospitalist medicine. Showing economic value to a hospital includes reducing tangible expenses. That means hospitalists who order fewer labs increase the bottom line for hospitals and increase the value they bring to the table. Some studies suggest up to 70% of the labs are unnecessary in making daily clinical decisions. 

One thing I try and do on a daily basis is decide if what I am ordering will change my management decisions from that point forward. If a patient's WBC count is 18K and the day before it was 25K, will checking it again tomorrow change what I am doing? Or will it just make me feel better that the trend continues.

One example is DKA. I was trained to order frequent labs, perhaps Q 4 hours. I have abandoned this practice years ago and have not found any clinically relevant loss of quality of outcomes in my patients.

I see wasted resources in laboratory being spent every day. I see daily chest x-rays for pneumonia. I see daily abdominal films for ileus. I see echos obtained left and right for reasons I can't even figure out. EEGs in the ICU which will always be abnormal, and rarely add clinical relevance to the case at hand. MRIs in clinical strokes that would offer nothing of clinical relevance to the patient's rehabilitation plans going forward. I see waste in every direction I turn. I see surgeries and procedures that have no relevance in the big picture, but when placed in a bubble make perfect sense.

Some of it is cover your butt medicine. Some of it is make me feel good medicine. Some of it is greed. Some of it ignorance. Some of it is just plain bad habits.  What ever the reason, it is expense. At least $275 a day per patient, per day.

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