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Objectives: Studies have shown that the overutilization of laboratory tests ("labs") for hospitalized patients is common and can cause adverse health outcomes. Our objective was to compare the ordering tendencies for routine complete blood counts (CBC) and chemistry panels by internal medicine residents and hospitalists.Methods: This observational study included a survey of medicine residents and hospitalists and a retrospective analysis of labs ordering data. The retrospective data analysis comprised patients admitted to either the teaching service or nonteaching hospitalist service at a single hospital during 2014. The survey asked residents and hospitalists about their practices and preferences on labs ordering. The frequency and timing of one-time and daily CBC and basic chemistry panel ordering for teaching service and hospitalist patients were obtained from our data warehouse. The average number of CBCs per patient per day and chemistry panels per patient per day was calculated for both services and multivariate regression was performed to control for patient characteristics.Results: Forty-four of 120 (37%) residents and 41 of 53 (77%) hospitalists responded to the survey. Forty-four (100%) residents reported ordering a daily CBC and chemistry panel rather than one-time labs at patient admission compared with 22 (54%) hospitalists (P < 0.001). For CBCs, teaching service patients averaged 1.72/day and hospitalist service patients averaged 1.43/day (P < 0.001). For basic chemistry panels, teaching service patients averaged 1.96/day and hospitalist service patients averaged 1.78/day (P < 0.001). Results were similar in multivariate regression models adjusting for patient characteristics.Conclusions: Residents' self-reported and actual use of CBCs and chemistry panels is significantly higher than that of hospitalists in the same hospital. Our results reveal an opportunity for greater supervision and improved instruction of cost-conscious ordering practices. [ABSTRACT FROM AUTHOR]

Objectives: Hospitalized oncology patients receive care from a variety of professionals, each of whom plays a role in decisions related to blood transfusions. We sought to examine differences in transfusion practices based on professional role, years of experience, and patient clinical scenario.Methods: We surveyed general medicine residents, hospitalists, and oncologists caring for inpatients at a large academic medical center between August 2013 and June 2014. Respondents reported transfusion practices in three different patient scenarios: a generally healthy patient, a patient with solid tumor malignancy, and a patient with hematologic malignancy. We also assessed rationale for transfusion practices. Bivariate comparisons of respondent characteristics and transfusion threshold were conducted using the Fisher exact test. Multivariate logistic regression was performed to assess the relative relations among professional role, years in practice, clinical scenario, and transfusion threshold <7 g/dL.Results: Of 158 physicians surveyed, 97 responded (61.4%). In bivariate analyses, fewer oncologists than residents or hospitalists used a threshold of <7 g/dL, but the result was significant for only one of three scenarios. The multivariate odds of transfusing at a threshold <7 g/dL were significantly higher among nononcologists (odds ratio [OR] 2.10, 95% confidence interval [CI] 1.03-4.28). Residents and practitioners in practice for <4 years also were more likely to use a threshold <7 g/dL (OR 1.82, 95% CI 0.99-3.33). Providers were less likely to use a restrictive threshold when an underlying malignancy was present (solid tumor OR 0.31, 95% CI 0.15-0.64; hematologic malignancy OR 0.34, 95% CI 0.16-0.70).Conclusions: Transfusion thresholds differed based on professional role, years in practice, and patient scenario. Further research is needed to determine the optimal transfusion threshold for oncology patients. [ABSTRACT FROM AUTHOR]