Implementing an Evidence-Based Protocol to Reduce Inappropriate Laboratory Test Ordering


      • Unnecessary laboratory tests are the leading expenditure to the US health care budget.
      • Overordering contributes to overdiagnosis and incidental findings.
      • The laboratory test ordering checklist can reduce overuse rates of comprehensive metabolic panel, lipid, and hemoglobin A1c tests.
      • Improvements in laboratory test ordering can reduce health care costs, enhance practice efficiencies, and promote evidence-based care.


      Excessive or inappropriate laboratory test ordering is a major contributor to rising health care costs, incidental findings, and overdiagnosis. A community-based, free clinic in South Carolina lacked a standard protocol for laboratory test use, contributing to an overuse rate of 40% in comprehensive metabolic panels, lipid panels, and hemoglobin A1c tests. After a multidisciplinary, evidence-based protocol was implemented that involved a checklist and provider feedback, the rate of laboratory test overuse decreased by 50%. The purpose of this quality improvement project is to implement an evidence-based standardized protocol to improve utilization and best practice of laboratory test ordering.


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      Elizabeth Glauser, DNP, FNP-C, is a doctorate of nursing practice graduate from the Medical University of South Carolina in Charleston and can be contacted at [email protected] .