“Striking” Down Overuse: The Effect of an Employee Strike on Ordering Practices at an Academic Medical Center

1University of California, San Francisco, San Francisco, CA

Meeting: Hospital Medicine 2014, March 24-27, Las Vegas, Nev.

Abstract number: 176


There has been a growing emphasis on increasing the value of healthcare by reducing unnecessary testing to decrease costs, though physician behavior has proven difficult to change. An event leading to reduced inpatient resources, such as with a natural or man‐made disaster, may cause physicians to be judicious about resource allocation and may provide insight into their overall ordering behavior. We sought to study the impact of a two‐day employee strike on ordering practices at an academic medical center.


During an employee strike affecting five academic medical centers in California on May 21st and 22nd, 2013, providers were strongly encouraged to decrease unnecessary diagnostic testing. We performed a retrospective analysis of laboratory and radiology utilization at our institution during the two‐day strike, adjusted for the reduced census and compared to the historical norms. We analyzed laboratory and radiology utilization for the entire medical center, as well as specifically on both an acute care general surgery and medical ward.


Across the medical center, laboratory utilization (normalized by inpatient‐days) decreased during the strike, but quickly returned back to baseline levels following the strike. Laboratory utilization prior to the strike was nearly three times higher on the medical ward, with an average of 35.1 orders per inpatient day, compared to the surgical ward (Figure 1). On the medical ward, laboratory utilization decreased starting the day before the strike and stayed significantly below average through the day after the strike, with a nadir of 11.7 orders per inpatient day. Laboratory utilization on the surgical ward increased above average on the day prior to the strike, decreased below average on the first day of the strike, but then returned to the baseline by the second day of the strike.

At baseline, radiology utilization was approximately three times higher on the surgical ward compared to the medical ward. On the day prior to the strike, radiology utilization on the surgical ward increased, whereas utilization decreased on the medicine ward. During the strike, radiology utilization was at baseline levels for both the medical and surgical wards.


A two‐day strike with a perceived decrease in resources and an associated educational campaign was associated with a significant decrease in laboratory utilization but no significant change in radiology utilization. The quick return to baseline ordering after the strike ended indicates that these changes in ordering practices may be difficult to sustain. This has important implications for the SHM Choosing Wisely recommendation aimed at decreasing routine inpatient labs.

To cite this abstract:

Hicks K, Stewart E, Moriates C, Benedetti N, Hamill T, Redberg R, Grady D, Sharpe B, Greene A. “Striking” Down Overuse: The Effect of an Employee Strike on Ordering Practices at an Academic Medical Center. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 176. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/striking-down-overuse-the-effect-of-an-employee-strike-on-ordering-practices-at-an-academic-medical-center/. Accessed March 31, 2020.

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