Daily Labs: A culture that needs ‘cancelling’

Call me ‘woke’ but I don’t subscribe to the culture of ordering daily labs for days in advance. I had an attending who advocated being very precise in ordering labs after initial admission & diagnosis. I had to explain exactly why I wanted a CBC in the morning and why not just a hemoglobin check or WBC ? Indeed as many 20 to 25% daily labs (CBC and electrolyte panels) get inappropriately ordered . It is also a documented issue and expense in a study done in Canada. Unnecessary labs come with cost (testing and staff cost), discomfort, iatrogenic anemia (medical vampirism) and can reduce patients quality of experience. I have seen daily INRs thrown in with daily CBCs and CMPs in cirrhotics with no interventions needing to be being done with daily ups and downs.

A opinion piece published in December 2022 argues this really is not big of a deal as projected and maybe doesn’t have to be a priority quality project for hospitals. I disagree for the following reasons:

1. The paper misses the point that our phlebotomy staff is a limited resource, especially these days. The labs you might actually want acutely and including those for timely discharges get delayed because the limited phlebotomy staff is busy with the bulk of low-value daily labs. Delayed discharges are expensive to hospitals
2. Patient discomfort cannot be quantified in terms of money, but in the last 10 years as a Hospitalist doc I have seen enough patients pissed off about their daily lab draws with the early morning sleep disruption and the pain and bruising and phlebitis especially when they are difficult pokes, which can have cascading effects. An irate patient refusing participating in physical therapy is a common example.
3. Daily draws can contribute to a small extent to iatrogenic anemia but is easily exacerbated by IV fluids that are often given, which is a separate issue that I touched on before.

If neither clinicians or hospitals are incentivized enough for this culture change – maybe patients need to start questioning the need for daily labs. If you are involved in teaching medicine – I urge you to draw attention on this issue to the next generation of clinicians!