Medical Laboratory Science
Canadian Society for Medical Laboratory Science
Last updated: October 2025
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Phlebotomy is not a risk-free event for the patient or the healthcare worker. While rare, injury from needlestick and/or pathogen exposure can occur. Cumulative blood loss due to multiple phlebotomy episodes can result in iatrogenic anemia, particularly in the elderly, children, or those with medical conditions. This anemia can lead to worsened patient outcomes. Employing mechanisms that limit the amount of blood taken has been shown to lessen the severity of iatrogenic anemia. This can range from using smaller-volume collection tubes, consulting about the possibility of add-on testing to previously drawn samples, or adopting a maximum blood volume policy. Addressing duplicate requisitions can limit a patient from being phlebotomized twice.
Sources:
Auta A, et al. Global prevalence of percutaneous injuries among healthcare workers: a systematic review and meta-analysis. Int J Epidemiol 2018;47(6):1972-80. PMID: 30272173.
Chandrashekar S. Hospital-Acquired anemia: A hazard of hospitalization. Glob J Transfus Med 2018;3:83-7
Dale JC, et al. Specimen collection volumes for laboratory tests: A College of American Pathologists Study of 140 Laboratories. Arch Pathol Lab Med 2003;127:62-68. PMID: 12562229.
Loh TP, et al. Clinical value of add-on chemistry testing in a large tertiary-care teaching hospital. Lab Med 2012;43(2):82-85.
Society for the Advancement of Blood Management. Anemia prevention and management program implementation guide. The Center for Hospital Innovation & Improvement. [Internet]. 2015. [cited 2015].
Whitehead N, et al. Interventions to prevent iatrogenic anemia: a Laboratory Medicine Best Practises systematic review. Crit Care 2019;23:278. PMID: 31399052.
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The quality of specimens received in the laboratory is paramount to obtaining accurate results. Proceeding with testing in the presence of poor sample quality may give misleading results. This contributes to delays and unnecessary repeat examinations. Any level of error should be avoided to decrease negative impact on clinical decisions and patient care. Laboratory professionals should be proactive in ensuring that all types of specimens are collected in a high quality manner with correct identification, regardless of which health professional group is performing the act.
Sources:
Chavan PD, et al. Reduction in sample rejections at the pre-analytical phase – Impact of training in a tertiary care oncology center. J Lab Physicians 2019;11(3):229-33. PMID: 31579248.
Ho J, et al. The impact of sputum quality on tuberculosis diagnosis: a systematic review. Int J Tuberc Lung Dis 2015;19(5):537-44. PMID: 25868021.
Howanitz PJ, et al. Clinical laboratory quality practices when hemolysis occurs. Arch Pathol Lab Med 2015;139:901-6. PMID: 26125430.
Lippi G, et al. Blood sample quality. Diagnosis 2019;6(1):25-31. PMID: 29794250.
O’Neill E, et al. Strict adherence to a blood bank specimen labeling policy by all clinical laboratories significantly reduces the incidence of “wrong blood in tube”. Am J Clin Pathol 2009;132:164-8. PMID: 19605809.
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Frequently called ‘just-in-case’, ‘rainbow draws’ or simply ‘extra tubes’, blood collected before tests are ordered is frequently unused and ultimately discarded. This represents a waste of laboratory resources and a challenge for specimen management. Excessive phlebotomy is a recognized contributor to iatrogenic anemia, which is linked to worsened patient outcomes.
Sources:
Gray A. Drawing extra blood tubes in the ED. Med Lab Observer [Internet]. 2012 [cited 2012].
Humble RM, et al. The “Rainbow” of extra blood tubes – Useful or wasteful practise? JAMA Int Med 2017:177(1):128-9. PMID: 27820611.
Loh TP, et al. Extra blood tubes – an affordable excess? Clin Chim Acta 2010:411:1544-5. PMID: 20542023.
Snozek CLH, et al. “Rainbow Draws” in the emergency department: clinical utility and staff perceptions. J Appl Lab Med 2019:4(2);229-234. PMID: 31639668.
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Many analytes have known stability profiles or minimum retesting intervals. In most cases, values will not change during this time. These intervals may be longer than traditional or historical test repeat ordering frequency. Ordering tests more frequently is unlikely to provide clinically meaningful results, and may contribute to iatrogenic anemia. Iatrogenic anemia can worsen patient outcomes. Laboratorians can play an active role in drawing awareness to and/or acting to reduce these types of orders.
Sources:
Chami N, et al. Rates of inappropriate laboratory test utilization in Ontario. Clin Bioch 2017:50;822-7. PMID: 28483406.
Compton M, et al. Duplicate type and screen testing waste in the clinical laboratory. Arch Path Lab Med 2018; 142(3):358-63. PMID: 29210591.
Eaton K, et al. Evidence-based guidelines to eliminate repetitive laboratory testing. JAMA Int Med 2017:177(12);1833-9. PMID: 29049500.
Lang T, et al. National minimum retesting intervals in pathology. A final report detailing consensus recommendations for minimum retesting intervals for use in pathology. Report by The Royal College of Pathologists. [Internet]. 2021 [cited 2021].
Tchou MJ, et al. Reducing electrolyte testing in hospitalized children by using quality improvement methods. Pediatrics 2018:141(5):e20173187. PMID: 29618583.
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With modern instrumentation, analytical precision is very high when the result is within the reportable range and no delta checks have failed. Providing that sample integrity and performance validity has been confirmed, repeating critical values rarely changes the result. However, turnaround time is significantly increased. This can delay clinical action, negatively impact patient care, and increase the likelihood of unnecessary investigations.
Sources:
Lehman CM, et al. Utility of repeat testing of critical values. A Q-probes analysis of 86 clinical laboratories. Arch Pathol Lab Med 2014:138:788-93. PMID: 24878017.
Motie PB, et al. Does routine repeat testing of critical laboratory values improve their accuracy? Med J Islam Repub Iran 2015;29:176 PMID: 26034729.
Onyenekwu CP, et al. The impact of repeat-testing of common chemistry analytes at critical concentrations. Clin Chem Lab Med 2014;52(12):1739-45. PMID: 24940715.
Sun SP, et al. Repeating critical hematology and coagulation values wastes resources, lengthens turnaround time, and delays clinical action. Am J Clin Path 2018:149;247-52. PMID: 29425259.
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Over-testing is a recognized problem, and evidence supports multi-faceted interventions that capitalize on advances in computer-based ordering technology. Bundling of tests may provide results that are not necessary for the ordering professional and may lead to duplication of testing or unnecessary follow-up. Order sets should be regularly reviewed. Research supports increased collaboration of all healthcare providers, including laboratory personnel, in combating over-testing. Laboratory professionals can be involved at all stages of interventions from problem recognition, feedback provision, to participation in the creation of supportive education materials and ordering guidelines.
Sources:
Ferraro S, et al. The role of the laboratory in ensuring appropriate test requests. Clin Bioch 2017;50(10-11):555-61. PMID: 28284827.
Jackups R, et al. Clinical decision support for hematology laboratory test utilization. Int J Lab Hem 2017;39:128-35. PMID: 28447421.
Krasowski M, et al. Promoting improved utilization of laboratory testing through changes in an electronic medical record: Experience at an academic medical center. BMC Med Inform Decision 2015;15(1):11. PMID: 25880934.
Rubinstein M, et al. Effectiveness of practises to support appropriate laboratory test utilization. A laboratory medicine best practises systematic review and meta-analysis. Am J Clin Path 2018;149(30):197-221. PMID: 29471324.
Nazerian P, et al. Appropriate use of laboratory test requests in the emergency department: a multilevel intervention. Eur J Emerg Med 2019;26(3):205-11. PMID: 29176456.
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Standing orders without an expiry or review date allow testing to be performed repetitively for extended periods of time. This type of testing is rarely clinically necessary without regularly reviewing the validity of the order. This contributes to overutilization of laboratory tests, and may exacerbate the development of iatrogenic anemia.
Sources:
Iturrate E, et al. Optimize your electronic medical record to increase value: Reducing laboratory overutilization. Am J Med. 2016;129(2):215-20. PMID: 26475957.
Raad S, et al. Reduction of laboratory utilization in the intensive care unit. J Int Care Med 2017:32(8);500-7. PMID: 27251106.
Studnicki J, et al. Measuring the impact of standing orders on laboratory utilization. Lab Med 1992:23(1);24-8.
Wertheim B, et al. An educational and administrative intervention to promote rational laboratory test ordering on an academic general medicine service. Am J Med 2017:130(10);47-53. PMID: 27619354.
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Inappropriate laboratory testing wastes time, effort, and energy, and may result in patient harm. Research demonstrates that focused testing strategies in response to clear clinical questions improves the utility of laboratory results. Laboratory professionals can play an important role in clinical conversations with the ordering professional to ensure testing addresses a specific clinical indication.
Sources:
McDonald EG, et al. Mindfulness-Based Laboratory Reduction: Reducing Utilization Through Trainee-Led Daily ‘Time Outs’. Am J Med. 2017 Jun;130(6):e241-e244. PMID: 28161348.
Squires JE, et al. Inappropriate use of clinical practices in Canada: a systematic review. CMAJ. 2022 Feb 28;194(8):E279-E296. PMID: 30744703.
White TE, et al. Strategies for laboratory professionals to drive laboratory stewardship. Pract Lab Med. 2021 Jul 24;26:e00249. PMID: 34381860.
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Preserving and respecting patient dignity and autonomy is the responsibility of all health care professionals. While there have been positive advancements, futile tests and interventions at the end of life are not uncommon. Phlebotomy can cause discomfort and significant imposition, and the tests may not be in line with the patient’s wishes. In these cases, medical laboratory professionals should be willing to advocate for the patient and question whether the diagnostic tests are essential.
Sources:
Binda F, et al. Quality of dying in hospital general wards: a cross-sectional study about the end-of-life care. BMC Palliat Care. 2021 Oct 12;20(1):153. PMID: 34641824.
Cardona-Morrell M, et al. Non-beneficial treatments in hospital at the end of life: a systematic review on extent of the problem, Int J for Qual Health Care 2016;28(4);456-69 PMID: 27353273.
Geijteman ECT, et al. Interventions in hospitalised patients with cancer: the importance of impending death awareness. BMJ Supportive & Palliative Care 2018;8:278-281. PMID: 29440148.
Magelssen M, et al. Blood sampling from dying patients: an ethical dilemma. Clin Ethics. 2012;7(3):107-10.
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Automated differentials consider thousands of cells, compared to a standard of 100 on a manual differential. On a properly validated modern instrument, auto-diffs are highly reliable. Manual differentials are laborious, time-consuming, and prone to variation. A complete-blood-count with differential (CBC w/diff) is a common test, often ordered repeatedly on in-patients. In most cases, a repeated white blood cell differential within 24 hours does not add clinical value.
Sources:
Phelan MP, et al. Impact of interventions to change CBC and differential ordering patterns in the emergency department. Am J Clin Pathol. 2019 Jan 7;151(2):194-197. PMID: 30247523.
Shen JZ, et al. Optimization of laboratory ordering practices for complete blood count with differential. Am J Clin Pathol. 2019;151(3):306-15. PMID: 30357374.
Starks RD, et al. Use of middleware data to dissect and optimize hematology autoverification. J Pathol Inform. 2021;12:19. PMID: 34221635.
Tran A, et al. Sustainable laboratory-driven method to decrease repeat, same-day WBC differentials at a tertiary care center. Am J Clin Pathol. 2022;157(4):561-5. PMID: 34617986.
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Blood products are finite, valuable resources. They need careful inventory management to prevent shortages, and a strained national supply adds stress to the system. Restrictive transfusion approaches are evidence- based, and vitally important to patient safety. Inappropriate transfusions put patients at additional risks that can cause poor outcomes. Medical laboratory professionals have an important role to play in screening transfusion orders carefully to minimize potential harms and healthcare costs, and advocating for programs that decrease inappropriate transfusion practices such as Using Blood Wisely (Choosing Wisely Canada).
Sources:
Czempik PF, et al. Appropriateness of allogeneic red blood cell transfusions in non-bleeding patients in a large teaching hospital: a retrospective study. J Clin Med. 2023;12(4):1293. PMID: 36835829.
Hill-Strathy M, et al. Evaluating the appropriateness of platelet transfusions compared with evidence-based platelet guidelines: An audit of platelet transfusions at 57 hospitals. Transfusion. 2021;61(1):57-71. PMID: 33078852.
Kron AT, et al. A prospective multi-faceted interventional study of blood bank technologist screening of red blood cell transfusion orders: The START study. Transfusion. 2021;61(2):410-422. PMID: 33423316.
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Many individuals, including healthcare professionals, can have trouble applying probabilistic diagnostic information into evidence-based decisions. This also includes those ordering the diagnostic tests. This is becoming increasingly important as more testing is promoted for low-risk patients, such as genetic tests. Performance capabilities of every laboratory test varies and is highly influenced by population prevalence. Laboratorians can advocate for practices that enhance interpretation of test results to improve clinical decision-making.
Sources:
Manrai AK, et al. Medicine’s uncomfortable relationship with math: calculating positive predictive value. JAMA Intern Med. 2014;174(6):991–93. PMID: 24756486.
Morgan DJ, et al. Accuracy of practitioner estimates of probability of diagnosis before and after testing. JAMA Intern Med. 2021;181(6):747–755. PMID: 33818595.
Stovitz SD. The inability to calculate predictive values: an old problem that has not gone away. Med Sci Educ. 2020; 30:685–8. PMID: 34457725.
Whiting PF, et al. How well do health professionals interpret diagnostic information? A systematic review. BMJ Open 2015;5:e008155. PMID: 26220870.
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Asymptomatic bacteriuria is a common, yet insignificant, finding that can lead to inappropriate treatment, including provision of unnecessary antimicrobials. This can exacerbate the development and spread of antimicrobial resistant organisms, which has significant healthcare cost and patient safety ramifications. Medical laboratory professionals can support antimicrobial stewardship by ensuring that urinalysis with culture only be performed on patients with appropriate symptoms by consulting with the ordering clinician or providing clear decision support systems.
Sources:
Claeys KC, et al. Optimal urine culture diagnostic stewardship practice-results from an expert modified-delphi procedure. Clin Infect Dis. 2022 Aug 31;75(3):382-9. PMID: 34849637.
Piggott KL, et al. Reducing unnecessary urine culture testing in residents of long term care facilities. BMJ. 2023 Aug 9;382:e075566. PMID: 37558239.
Vaughn VM, et al. A statewide quality initiative to reduce unnecessary antibiotic treatment of asymptomatic bacteriuria. JAMA Intern Med. 2023 Sept 1;183(9):933-41. PMID: 37428491.
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Impaired sleep is associated with increased patient discomfort and harm. The laboratory may contribute to sleep disturbances by waking patients for phlebotomy. Research in several institutions shows that scheduling changes, or actions to reduce inappropriate testing, can positively impact the issue of impaired sleep. Medical laboratory professionals should collaborate with clinical colleagues to redesign workflow or implement other measures to promote sleep.
Sources:
Grossman MN, et al. Awakenings? Patient and hospital staff perceptions of nighttime disruptions and their effect on patient sleep. J Clin Sleep Med. 2017;13(2):301–306. PMID: 27923432.
Morse AM, et al. Sleep in Hospitalized Patients. Clocks & Sleep. 2019; 1(1):151-165. PMID: 33089161.
Ramarajan V, et al. Implementation of later morning specimen draws to improve patient health and satisfaction. Lab Med 2016;47(1):e1-4. PMID: 26656891.
Ramazani SN, et al. Improving the timing of laboratory studies in hospitalized children: a quality improvement study. Hosp Pediatr July 2021; 11(7):670–8. PMID: 34158310.
Tapaskar N, et al. Evaluation of the order SMARTT: An initiative to reduce phlebotomy and improve sleep-friendly labs on general medicine services. J Hosp Med. 2020 Aug;15(8):479-482. PMID: 32804609.
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The Canadian Society for Medical Laboratory Science (CSMLS) formed a committee of medical laboratory professional (MLP) subject matter experts. They met in early 2023 to develop a strategy to create new recommendations. Subcommittees were formed to explore multiple sources of potential list items, including the list of deprioritized items from the first iteration to identify MLP recommendations in 2018-2019, laboratory-related items published by other societies in Choosing Wisely Canada and several other countries, and through leading discussions at their local sites. A long list of items was discussed at a meeting in June 2023, and forty-two were deemed potential candidates for further consideration. The committee then went through an asynchronous prioritization exercise to identify the most important recommendations with respect to frequency, potential for waste, potential for harm, and professional barriers to future action. The prioritization exercise identified the most important recommendations, which were subjected to analysis of the quality of published evidence supporting each recommendation. The draft recommendations were approved by the Board of Directors of the CSMLS in December 2023.
Sources:
Auta A, et al. Global prevalence of percutaneous injuries among healthcare workers: a systematic review and meta-analysis. Int J Epidemiol 2018;47(6):1972-80. PMID: 30272173.
Chandrashekar S. Hospital-Acquired anemia: A hazard of hospitalization. Glob J Transfus Med 2018;3:83-7
Dale JC, et al. Specimen collection volumes for laboratory tests: A College of American Pathologists Study of 140 Laboratories. Arch Pathol Lab Med 2003;127:62-68. PMID: 12562229.
Loh TP, et al. Clinical value of add-on chemistry testing in a large tertiary-care teaching hospital. Lab Med 2012;43(2):82-85.
Society for the Advancement of Blood Management. Anemia prevention and management program implementation guide. The Center for Hospital Innovation & Improvement. [Internet]. 2015. [cited 2015].
Whitehead N, et al. Interventions to prevent iatrogenic anemia: a Laboratory Medicine Best Practises systematic review. Crit Care 2019;23:278. PMID: 31399052.
Chavan PD, et al. Reduction in sample rejections at the pre-analytical phase – Impact of training in a tertiary care oncology center. J Lab Physicians 2019;11(3):229-33. PMID: 31579248.
Ho J, et al. The impact of sputum quality on tuberculosis diagnosis: a systematic review. Int J Tuberc Lung Dis 2015;19(5):537-44. PMID: 25868021.
Howanitz PJ, et al. Clinical laboratory quality practices when hemolysis occurs. Arch Pathol Lab Med 2015;139:901-6. PMID: 26125430.
Lippi G, et al. Blood sample quality. Diagnosis 2019;6(1):25-31. PMID: 29794250.
O’Neill E, et al. Strict adherence to a blood bank specimen labeling policy by all clinical laboratories significantly reduces the incidence of “wrong blood in tube”. Am J Clin Pathol 2009;132:164-8. PMID: 19605809.
Gray A. Drawing extra blood tubes in the ED. Med Lab Observer [Internet]. 2012 [cited 2012].
Humble RM, et al. The “Rainbow” of extra blood tubes – Useful or wasteful practise? JAMA Int Med 2017:177(1):128-9. PMID: 27820611.
Loh TP, et al. Extra blood tubes – an affordable excess? Clin Chim Acta 2010:411:1544-5. PMID: 20542023.
Snozek CLH, et al. “Rainbow Draws” in the emergency department: clinical utility and staff perceptions. J Appl Lab Med 2019:4(2);229-234. PMID: 31639668.
Chami N, et al. Rates of inappropriate laboratory test utilization in Ontario. Clin Bioch 2017:50;822-7. PMID: 28483406.
Compton M, et al. Duplicate type and screen testing waste in the clinical laboratory. Arch Path Lab Med 2018; 142(3):358-63. PMID: 29210591.
Eaton K, et al. Evidence-based guidelines to eliminate repetitive laboratory testing. JAMA Int Med 2017:177(12);1833-9. PMID: 29049500.
Lang T, et al. National minimum retesting intervals in pathology. A final report detailing consensus recommendations for minimum retesting intervals for use in pathology. Report by The Royal College of Pathologists. [Internet]. 2021 [cited 2021].
Tchou MJ, et al. Reducing electrolyte testing in hospitalized children by using quality improvement methods. Pediatrics 2018:141(5):e20173187. PMID: 29618583.
Lehman CM, et al. Utility of repeat testing of critical values. A Q-probes analysis of 86 clinical laboratories. Arch Pathol Lab Med 2014:138:788-93. PMID: 24878017.
Motie PB, et al. Does routine repeat testing of critical laboratory values improve their accuracy? Med J Islam Repub Iran 2015;29:176 PMID: 26034729.
Onyenekwu CP, et al. The impact of repeat-testing of common chemistry analytes at critical concentrations. Clin Chem Lab Med 2014;52(12):1739-45. PMID: 24940715.
Sun SP, et al. Repeating critical hematology and coagulation values wastes resources, lengthens turnaround time, and delays clinical action. Am J Clin Path 2018:149;247-52. PMID: 29425259.
Ferraro S, et al. The role of the laboratory in ensuring appropriate test requests. Clin Bioch 2017;50(10-11):555-61. PMID: 28284827.
Jackups R, et al. Clinical decision support for hematology laboratory test utilization. Int J Lab Hem 2017;39:128-35. PMID: 28447421.
Krasowski M, et al. Promoting improved utilization of laboratory testing through changes in an electronic medical record: Experience at an academic medical center. BMC Med Inform Decision 2015;15(1):11. PMID: 25880934.
Rubinstein M, et al. Effectiveness of practises to support appropriate laboratory test utilization. A laboratory medicine best practises systematic review and meta-analysis. Am J Clin Path 2018;149(30):197-221. PMID: 29471324.
Nazerian P, et al. Appropriate use of laboratory test requests in the emergency department: a multilevel intervention. Eur J Emerg Med 2019;26(3):205-11. PMID: 29176456.
Iturrate E, et al. Optimize your electronic medical record to increase value: Reducing laboratory overutilization. Am J Med. 2016;129(2):215-20. PMID: 26475957.
Raad S, et al. Reduction of laboratory utilization in the intensive care unit. J Int Care Med 2017:32(8);500-7. PMID: 27251106.
Studnicki J, et al. Measuring the impact of standing orders on laboratory utilization. Lab Med 1992:23(1);24-8.
Wertheim B, et al. An educational and administrative intervention to promote rational laboratory test ordering on an academic general medicine service. Am J Med 2017:130(10);47-53. PMID: 27619354.
McDonald EG, et al. Mindfulness-Based Laboratory Reduction: Reducing Utilization Through Trainee-Led Daily ‘Time Outs’. Am J Med. 2017 Jun;130(6):e241-e244. PMID: 28161348.
Squires JE, et al. Inappropriate use of clinical practices in Canada: a systematic review. CMAJ. 2022 Feb 28;194(8):E279-E296. PMID: 30744703.
White TE, et al. Strategies for laboratory professionals to drive laboratory stewardship. Pract Lab Med. 2021 Jul 24;26:e00249. PMID: 34381860.
Binda F, et al. Quality of dying in hospital general wards: a cross-sectional study about the end-of-life care. BMC Palliat Care. 2021 Oct 12;20(1):153. PMID: 34641824.
Cardona-Morrell M, et al. Non-beneficial treatments in hospital at the end of life: a systematic review on extent of the problem, Int J for Qual Health Care 2016;28(4);456-69 PMID: 27353273.
Geijteman ECT, et al. Interventions in hospitalised patients with cancer: the importance of impending death awareness. BMJ Supportive & Palliative Care 2018;8:278-281. PMID: 29440148.
Magelssen M, et al. Blood sampling from dying patients: an ethical dilemma. Clin Ethics. 2012;7(3):107-10.
Phelan MP, et al. Impact of interventions to change CBC and differential ordering patterns in the emergency department. Am J Clin Pathol. 2019 Jan 7;151(2):194-197. PMID: 30247523.
Shen JZ, et al. Optimization of laboratory ordering practices for complete blood count with differential. Am J Clin Pathol. 2019;151(3):306-15. PMID: 30357374.
Starks RD, et al. Use of middleware data to dissect and optimize hematology autoverification. J Pathol Inform. 2021;12:19. PMID: 34221635.
Tran A, et al. Sustainable laboratory-driven method to decrease repeat, same-day WBC differentials at a tertiary care center. Am J Clin Pathol. 2022;157(4):561-5. PMID: 34617986.
Czempik PF, et al. Appropriateness of allogeneic red blood cell transfusions in non-bleeding patients in a large teaching hospital: a retrospective study. J Clin Med. 2023;12(4):1293. PMID: 36835829.
Hill-Strathy M, et al. Evaluating the appropriateness of platelet transfusions compared with evidence-based platelet guidelines: An audit of platelet transfusions at 57 hospitals. Transfusion. 2021;61(1):57-71. PMID: 33078852.
Kron AT, et al. A prospective multi-faceted interventional study of blood bank technologist screening of red blood cell transfusion orders: The START study. Transfusion. 2021;61(2):410-422. PMID: 33423316.
Manrai AK, et al. Medicine’s uncomfortable relationship with math: calculating positive predictive value. JAMA Intern Med. 2014;174(6):991–93. PMID: 24756486.
Morgan DJ, et al. Accuracy of practitioner estimates of probability of diagnosis before and after testing. JAMA Intern Med. 2021;181(6):747–755. PMID: 33818595.
Stovitz SD. The inability to calculate predictive values: an old problem that has not gone away. Med Sci Educ. 2020; 30:685–8. PMID: 34457725.
Whiting PF, et al. How well do health professionals interpret diagnostic information? A systematic review. BMJ Open 2015;5:e008155. PMID: 26220870.
Claeys KC, et al. Optimal urine culture diagnostic stewardship practice-results from an expert modified-delphi procedure. Clin Infect Dis. 2022 Aug 31;75(3):382-9. PMID: 34849637.
Piggott KL, et al. Reducing unnecessary urine culture testing in residents of long term care facilities. BMJ. 2023 Aug 9;382:e075566. PMID: 37558239.
Vaughn VM, et al. A statewide quality initiative to reduce unnecessary antibiotic treatment of asymptomatic bacteriuria. JAMA Intern Med. 2023 Sept 1;183(9):933-41. PMID: 37428491.
Grossman MN, et al. Awakenings? Patient and hospital staff perceptions of nighttime disruptions and their effect on patient sleep. J Clin Sleep Med. 2017;13(2):301–306. PMID: 27923432.
Morse AM, et al. Sleep in Hospitalized Patients. Clocks & Sleep. 2019; 1(1):151-165. PMID: 33089161.
Ramarajan V, et al. Implementation of later morning specimen draws to improve patient health and satisfaction. Lab Med 2016;47(1):e1-4. PMID: 26656891.
Ramazani SN, et al. Improving the timing of laboratory studies in hospitalized children: a quality improvement study. Hosp Pediatr July 2021; 11(7):670–8. PMID: 34158310.
Tapaskar N, et al. Evaluation of the order SMARTT: An initiative to reduce phlebotomy and improve sleep-friendly labs on general medicine services. J Hosp Med. 2020 Aug;15(8):479-482. PMID: 32804609.
About Choosing Wisely Canada
Choosing Wisely Canada is the national voice for reducing unnecessary tests and treatments in health care. One of its important functions is to help clinicians and patients engage in conversations that lead to smart and effective care choices.
Web: choosingwiselycanada.org
Email: info@choosingwiselycanada.org
Twitter: @ChooseWiselyCA
Facebook: /ChoosingWiselyCanada
Using Blood Wisely
A national campaign that aims to reduce unnecessary red blood cell transfusions in hospital settings.
Using Labs Wisely
A national consortium that’s changing the lab utilization landscape in Canada.