What is it about?

When a patient comes to the ER for evaluation of a mental health crisis such as depression feeling suicidal, it is the ER doctor's duty to evaluate for possible medical causes of the patient's symptoms. This has always included a panel of what are called screening lab tests such as blood counts, electrolytes, kidney function, thyroid function and others. Previous studies have shown that these screening lab tests tend to be very low yield unless the doctor suspects a medical cause. In other words, most patients who come in with depression symptoms don't have an infection or low blood counts or kidney failure causing their symptoms. However, the medical community has been reluctant to get rid of policies requiring that these tests be ordered ("just to be safe"). Our hospital ended the policy of requiring routine labs and we studied how this affected patient care. We found that we could save a lot of money (over $130,000 in just a four month period), move patients through the ER and hospital more quickly and do this without any adverse patient outcomes such as increased consultations, transfers to the ICU or deaths. It is important to note that this study supports the removal of ROUTINE screening labs, not the removal of all screening labs. If a provider suspects a medical cause of symptoms, they should still order any screening lab tests that they deem necessary.

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Why is it important?

This study takes an important step in supporting the end of policies that require ROUTINE screening lab tests for patients with mental health crisis. Hospitals could save a lot of money without worry for unforeseen negative patient outcomes.


As an ER doctor, it is frustrating to me when a hospital policy requires the mindless ordering of lab tests. I see policies like these as an important cause of waste in the medical system. I am proud that with psychiatry support, our hospital took the step to end our policy of routine screening labs for patients being admitted in inpatient psychiatry. I am happy to be able to report our success and hope this can be a good example for others moving forward.

Michael Zwank

Read the Original

This page is a summary of: Elimination of Routine Screening Laboratory Tests for Psychiatric Admission: A Quality Improvement Initiative, Psychiatric Services, December 2020, American Psychiatric Association, DOI: 10.1176/appi.ps.202000121.
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