A multicentric intervention based on nudging for the reduction of potentially unnecessary laboratory tests: insights from a Swiss hospital network

Healthcare overuse is a widespread issue, accounting for approximately 10–30% of total healthcare costs. This study examines the impact of a computerized alert system designed to reduce inappropriate laboratory tests across five public hospitals in southern Switzerland. A 32-month observational study - between July 2021 and March 2024 - was conducted to assess the effectiveness of the alert system in discouraging unnecessary laboratory testing. Data were collected from five public hospitals where 12.4% of laboratory tests performed were identified as non-compliant with recommended minimal retesting intervals (MRI). Of these non-compliant tests, 11.4% were prevented by the alert system, indicating direct intervention efficacy. Distinct patterns in alert acceptance rates emerged over time. Hospital H4 showed a significant increase in alert acceptance, which may reflect contextual factors such as a work environment promoting open communication and kindness among healthcare professionals. Conversely, hospitals H1 and H5 experienced declining alert acceptance, likely due to habituation effects. A learning effect was suggested by a significant reduction in inappropriate tests for certain markers, such as C-Reactive Protein (CRP), over time. Following the alert’s implementation, the average rate of appropriate prescriptions across all hospitals was 87.5%. Specific tests, including PSA (19.4%), PTH (15.5%), ammonia (14.8%), and CRP (14.5%), had higher alert acceptance rates. The cost savings from avoided tests were estimated at EUR 1,642,417. This study confirms that computerized alerts represent a gentle, effective and cost-efficient method to reducing overtreatment, increasing awareness among healthcare professionals, and supporting personalized medicine. The findings suggest: hypothetically - that organizational environments fostering human-centered care, effective communication and kindness may enhance the impact of alert systems, warranting further empirical investigation.