Choosing Wisely:

Don’t order diagnostic tests at regular intervals (such as every day), but rather in response to specific clinical questions.

Rationale and Comments: Many diagnostic studies (including chest radiographs, arterial blood gases, blood chemistries and counts and electrocardiograms) are ordered at regular intervals (e.g., daily). Compared with a practice of ordering tests only to help answer clinical questions, or when doing so will affect management, the routine ordering of tests increases health care costs, does not benefit patients and may in fact harm them. Potential harms include anemia due to unnecessary phlebotomy, which may necessitate risky and costly transfusion, and the aggressive work-up of incidental and nonpathological results found on routine studies.
Sponsoring Organizations:
  • Critical Care Societies Collaborative–Critical Care
  • Sources:
  • Expert consensus
  • Disciplines:
  • Hematologic
  • References: • Flabouris A, Bishop G, Williams L, Cunningham M. Routine blood test ordering for patients in intensive care. Anaesth Intensive Care. 2000;28(5):562–5.
    • Ganapathy A, Adhikari NKJ, Spiegelman J, Scales DC. Routine chest x-rays in intensive care units: A systematic review and meta-analysis. Crit Care. 2012;16(2):R68.
    • May TA, Clancy M, Critchfield J, Ebeling F, Enriquez A, Gallagher C, Genevro J, Kloo J, Lewis P, Smith R, Ng VL. Reducing unnecessary inpatient laboratory testing in a teaching hospital. Am J Clin Pathol. 2006;126(2):200–6.

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