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Essential and Nonessential Blood Testing in the Clinical Teaching Unit

Sherren, Cody MSc*; Day, Andrew MSc; Ilan, Roy MD, MSc, FRCPC

doi: 10.1097/PTS.0000000000000363
Original Article: PDF Only

Objectives The aim of the study was to evaluate the essential and nonessential blood tests ordered on the internal medicine clinical teaching units (CTUs) at Kingston General Hospital. Our aim was to establish a baseline performance measure identifying appropriate use of laboratory tests that could be used to inform improvement over time.

Methods For an 8-week period, 14 CTU attending physicians at Kingston General Hospital were surveyed. They were asked for each of their patients, “What blood tests do you consider to be essential for tomorrow morning to maintain appropriate care for this patient?” The following day, blood tests that were ordered were compared with the “essential” list previously given by the attending physicians.

Results Of 291 processed blood tests, 148 (51%) had not been considered essential by attending physicians; of the 203 tests considered essential, 60 (30%) were not ordered. Total agreement between “essential” and processed tests was poor (κ = 0.51; confidence interval, 0.45–0.56).

Conclusions Inadequate use of blood tests for CTU patients is common. Quality improvement initiatives should aim to address the lack of observed consensus between attending physicians' views and the ordered tests and to streamline decision-making and the ordering/communication processes. Clinical standards and guidelines regarding ordering of laboratory tests should be clearly defined.

From the *Queen's University Medical School; and Departments of †Public Health Sciences and ‡Medicine, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada.

Correspondence: Roy Ilan, MD, MSc, FRCPC, Department of Medicine, Queen's University, 94 Stuart St, Etherington Hall, Room 1005, Kingston, Ontario K7L 3N6 (e-mail:

The authors disclose no conflict of interest.

This study was supported by the Southeastern Ontario Academic Medical Organization.

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