Han says the high numbers of tests were conducted because UCSF is a high-volume tertiary referral center for neurology that sees more than 2,000 patients a year, many of whom are housed in the intensive care unit, where the assumption is that they are critically ill.
"They are in some ways [critically ill], but probably not in the typical ways that a medicine patient in the ICU would be. They don't tend to have the same gamut of medical problems that the typical internal medicine service would see," he said.
"There is a habit in the ICU setting to order a lot of labs and daily labs just to see if anything is abnormal because there is this assumption that these patients are critically ill and any number of these lab tests can go wrong at any point."
"We were looking at the numbers of labs that we were actually ordering on the service and it is quite an astounding number as a product of the ICU as well as the sheer number of patients that we actually see on the service. You can imagine that compounded with a three-day ICU stay for the typical patient who is getting daily labs. That adds up to be quite a large number," Han said.
The residents worked with an internist who coordinated care with the neurologists and they identified the typical neurology patient and the standard lab tests they'd ordered. Han says they found that the five tests they most frequently ordered came back with normal results "the vast majority of the time. Not only that, but the times they were abnormal we had a very good reason why it was expected and it didn't impact our clinical care. We identified that as a potential area where we could make a significant impact in reducing the lab tests."