Doing things for no reason in the hospital

Why do we continue to do things for no reason in hospitals? Abraar Karan BMJ 2019;364:l841

It is with great interest that I read this insightful personal view. Back in 1987, as a Senior House Officer in a district general hospital, our Consultant Chemical Pathologist thought we were requesting too many blood tests at night time. For a week he asked us to call him personally between 10pm and 6am to ratify any request before calling the MLSO and asking for the test to be performed. The number of blood tests carried out dropped by a remarkable 80% during the test week. It was only afterwards that we were informed by the Consultant that he had denied not a single request during the trial period (though he did on occasion question the necessity, leading to an amicable withdrawal of the request). Memory does not serve to recollect whether the improvement was maintained.

This is in keeping with Dr Karan’s observations some 30 years later! Daily “unnecessary checklists” seem an excellent idea, as (of course) is the recommendation to question the rational for any investigation before committing to the cost (both financial and human), of proceeding. In the NHS, a dedicated and predictable “run” of laboratory and radiology testing at 7am, results being ready for 8am ward rounds, may further avoid some night time activity.