During my ICU fellowship, in addition to reviewing all the orders during rounds, I also questioned the frequency of labs. Just because a patient is admitted to the hospital (especially an ICU) does NOT mean he/she needs daily blood counts, metabolic profiles, coagulation assays, etc. In my opinion, this is a poor, cookie-cutter practice of medicine is an incredible waste of resources, time, and not to mention, causes iatrogenic morbidity for our patients (discomfort due to needle sticks, anemia, etc.)
To drill this point home with my residents, sometimes I’ll open a chart, pull up the last week of normal labs, and ask them what abnormalities they see. After carefully looking for signs of infection, anemia, renal impairment, coagulopathy, etc., they’ll invariably answer: “Rishi, I don’t know. Everything looks okay.” And they’re exactly right. Why do we need to check daily labs in patients who are otherwise asymptomatic… or in every post-operative patient… or in situations where we’re not following an acute change?
We don’t need to!
I implore all healthcare workers to individualize care for the patient in front of you, be mindful of every order (fluids, medication, therapies, labs), and eliminate the knee-jerk impulse to order daily labs “just in case.”
Drop me a comment with your thoughts!