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Daily Labs Are Obsolete

August 18, 2010

Point-of-care testing should change our routines for patient assessment.

 Traditionally, physicians have ordered daily laboratory tests, especially for their most critically ill patients.  In most hospitals, these blood counts and electrolyte levels are drawn early in the morning, often at 4 am or earlier, waking patients from their sleep.  In contrast to newer technologies, this practice has never been seriously challenged despite the lack of data demonstrating that routine daily labs improve outcomes or reduce costs.  It’s not even certain the tests pay for themselves.

 Routine daily laboratory testing is simply a tradition from the days when it took a few hours to have their results returned.  Physicians making morning rounds felt they needed to see the results at the time of rounds in order to make a full assessment of the patient’s status.  This could only be accomplished by having the laboratory tests drawn early in the morning, often dispatching teams of phlebotomists throughout the hospital, and batch running all these tests at once in an increasingly overburdened laboratory.  In truth, many of the tests run may not have been absolutely necessary, but were done only to be sure that everything was available when the physician assessed the patient on rounds.

 A paradigm shift in medicine is long overdue.  Point-of-care testing (POCT) has been available for most of the routine laboratory tests performed for over a decade.  POCT is accurate and rapid, typically only taking a few minutes to generate the results.  Yet few hospitals and physician practices have completely latched onto these techniques.

 The real improvements in quality will come when POCT actually changes practice.  Selective testing based upon the clinical examination of the patient should be the approach.  Because turnaround is so rapid, no routine daily lab testing would be necessary.  Instead, the physician should test at the time of rounds using POCT.

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