Choosing Daily Labs Wisely in the Hospital: A Novel Tool for Assessing Laboratory Testing Appropriateness : Quality Management in Healthcare

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Choosing Daily Labs Wisely in the Hospital: A Novel Tool for Assessing Laboratory Testing Appropriateness

Murphy, Caleb J. MD, MBA; Duran, Alisa M. MD; Diem, Susan J. MD, MPH; Bowman Peterson, Jill M. MD

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Quality Management in Health Care 29(3):p 169-172, July/September 2020. | DOI: 10.1097/QMH.0000000000000258

Abstract

Background: 

The Minnesota Lab Appropriateness (MLAB) criteria were developed for assessing appropriateness of complete blood counts (CBCs) and serum electrolyte panels (SEPs) ordered for adult inpatients.

Methods: 

Two independent raters used the MLAB criteria to rate appropriateness of labs ordered during 50 hospitalizations through retrospective medical record review.

Results: 

Evaluation of 208 CBCs and 253 SEPs on a 2-category scale (appropriate/inappropriate) resulted in an inappropriate lab rate of 24% and 25% for CBCs and SEPs, respectively. Using a 3-category Likert scale that included an “equivocal” rating to allow for clinical uncertainty, 17% of CBCs and 20% of SEPs were considered inappropriate. Interrater reliability was “substantial” using the dichotomous scale for both CBCs and SEPs. Using the 3-category Likert scale, reliability was “substantial” for CBCs and “moderate” for SEPs.

Conclusion: 

The MLAB criteria identified inappropriate labs at a rate consistent with published figures, with good interrater reliability.

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