Clinical question: Is there a difference in the ordering of laboratory tests between teaching and nonteaching hospitals?
Background: There is a general impression that trainees at teaching hospitals order more unnecessary laboratory testing, compared with those at nonteaching hospitals, but there are not enough data to support this generalization. In addition, there may be factors at teaching hospitals that influence these results.
Study design: Cross-sectional study.
Setting: Teaching and nonteaching hospitals.
Synopsis: Investigators used the Texas Inpatient Public Use Data file to examine hospital discharges from both teaching and nonteaching hospitals with a discharge diagnosis of cellulitis or pneumonia. There were a greater number of laboratory tests ordered at teaching hospitals, compared with nonteaching hospitals. For pneumonia, there were an additional 3.6 tests ordered per day, and for cellulitis, there were an additional 2.6 tests ordered per day. This finding was statistically significant, even when adjusted for illness severity, length of stay, and patient demographics.
This study did not account for confounding diagnoses that may have influenced ordering or the prescribing habits of different practitioner groups (such as residents, attending physicians, or advanced practice providers).
Bottom line: There is an increase in laboratory test orders in teaching versus nonteaching hospitals for pneumonia and cellulitis.
Citation: Valencia V et al. A comparison of laboratory testing in teaching vs nonteaching hospitals for 2 common medical conditions. JAMA Intern Med. 2018 Jan 1;178(1):39-47.
Dr. Shaffie is a hospitalist at Denver Health Medical Center and an assistant professor of medicine at the University of Colorado at Denver, Aurora.