Low Diagnostic Utility of Rechecking Hemoglobins Within 24 Hours in Hospitalized Patients

Abstract

Purpose Clinicians often repeat hemoglobin tests within a 24 hour period to detect or monitor anemia. We sought to determine the percentage of hemoglobin tests repeated within a single hospital day that were at least 1.0 g/dL lower than the first test. Methods We performed a retrospective cross-sectional analysis of hospitalized adults on medical or surgical services over a year at a single academic hospital. Using patient and laboratory data in the electronic health record, we analyzed the proportion of repeated hemoglobin tests that was at least 1 g/dL less than the initial hemoglobin value of that day, excluding days when transfusions were administered. Results A total of 88,722 hemoglobin tests were obtained from 12,877 unique patients, who contributed a total of 86,859 hospitalization days. In 12,230 (14.1%) of those days, two or more hemoglobin tests were obtained within a single day. In the 6,969 patients who had two hemoglobin tests obtained on the same day and no transfusions given, 949 (13.5%) were ≥ 1 g/dL lower than the initial hemoglobin value of that day and 260 (3.7%) were ≥ 2 g/dL lower. Repeated tests did not often reach transfusion thresholds: 482(6.9%) of repeat hemoglobin values were < 8 g/dL and 64 (0.9%) were < 7 g/dL. Conclusions Hemoglobin tests were repeated in 14% of hospital days. For patients who had two hemoglobin tests obtained on the same day, 13.5% demonstrated a clinically significant drop. This information may be helpful to clinicians when considering whether repeat testing is appropriate.

Evaluating Automated Rules for Rapid Response System Alarm Triggers in Medical and Surgical Patients

“…Lastly, because we were unable to ascertain the timing of the hematocrit values within the first 24 hours of admission, we excluded both patients with preexisting anemia on admission and those who developed HAA within the first 24 hours of admission, which is not uncommon. 26 Thus, we were unable to assess the effect of acute on chronic anemia arising during hospitalization and HAA that develops within the first 24 hours, both of which may also be harmful. 18,27,28 …”

Mindfulness-Based Laboratory Reduction: Reducing Utilization Through Trainee-Led Daily ‘Time Outs’

“…5 Routine repeated testing, particularly for common tests such as the complete blood count, is seldom helpful in clinical management. 6 For these reasons, several professional societies recommend the avoidance of routine laboratories in stable patients. 7 This trainee-designed and -led initiative sought to translate such recommendations into action by implementing and Funding: This project was completed without any internal or external funding.…”

Incidence, Predictors, and Outcomes of Hospital‐Acquired Anemia

“…Third, given the relatively few number of patients with severe HAA in our cohort, we were unable to assess if the association of severe HAA differed by suspected etiology. Lastly, because we were unable to ascertain the timing of the hematocrit values within the first 24 hours of admission, we excluded both patients with preexisting anemia on admission and those who developed HAA within the first 24 hours of admission, which is not uncommon 26 . Thus, we were unable to assess the effect of acute on chronic anemia arising during hospitalization and HAA that develops within the first 24 hours, both of which may also be harmful 18,27,28 …”

“…Lastly, because we were unable to ascertain the timing of the hematocrit values within the first 24 hours of admission, we excluded both patients with preexisting anemia on admission and those who developed HAA within the first 24 hours of admission, which is not uncommon. 26 Thus, we were unable to assess the effect of acute on chronic anemia arising during hospitalization and HAA that develops within the first 24 hours, both of which may also be harmful. 18,27,28 In conclusion, severe HAA occurs in 1.4% of all medical hospitalizations and is associated with increased odds of death or readmission within 30 days.…”