Use of the Laboratory in a Teaching Hospital: Implications for Patient Care, Education, and Hospital Costs

Abstract

Laboratory studies contribute significantly to the cost of hospitalization. Arguments for the liberal use of laboratory tests are countered by concern over costs and the need for young physicians to develop bedside skills. This report reviews the current use of laboratory services for patients hospitalized on the Medical Service of the University of Rochester Medical Center. During a 14-day hospitalization the average patient received 69 tests at a cost of $469, or roughly one fourth of the hospital bill. Patterns of laboratory use may bear little relation to the needs of the patient for optimal care. The data suggest that follow-up laboratory studies are excessive. The house staff has responded to these data by identifying factors contributing to overuse and by developing rational guidelines for the optimal use of laboratory tests. Further studies are necessary to determine how often the results of laboratory tests influence diagnostic or therapeutic decisions or affect the outcome of care.