Does admission order form design really matter? A reduction in urea blood test ordering

Abstract

IntroductionLaboratory blood testing is one of the most high-volume medical procedures and continues to increase steadily with instances of inappropriate testing resulting in significant financial implications. Studies have suggested that the design of a standard hospital admission order form and laboratory request forms influence physician test ordering behaviour, reducing inappropriate ordering and promoting resource stewardship.Aim/methodTo redesign the standard medicine admission order form-laboratory request section to reduce inappropriate blood urea nitrogen (BUN) testing.ResultsA redesign of the standard admission order form used by general internal medicine physicians and residents in two large teaching hospitals in one health zone in Alberta, Canada led to a significant step reduction in the ordering of the BUN test on hospital admission.ConclusionsRedesigning the standard medicine admission order form-laboratory request section can have a beneficial effect on the reduction in BUN ordering altering physician ordering patterns and behaviour.

Successful demand management in diagnostic immunology testing

“…Under this, ours is ‘automation and computerisation’, a design-oriented intervention, and second in effectiveness only to forced restraint—that is, vetting, disallowing or restricting ordering to limited time windows. Poorly designed computerisation (eg, poor arrangement of on-screen presentation of test order sets) can actively encourage poor clinician decisions by ordering staff; instead good design makes use of ‘nudge’ principles and defaults to encourage ‘good’ user behaviour 7 35. Further, computerised ordering can have large, wide and systemic impact to standardise practice; however, access to resources to modify IT systems can be a barrier 35.…”

“…In this paper, we describe the development, implementation and impact of algorithms providing primary care clinicians with information to help them make decisions about test requesting while the patient is with them in the clinic. Such approaches have been successful in other clinical and geographical areas 2 6 7. We described algorithms for four sets of diagnostic immunology tests (antinuclear antibodies (ANAs), allergen-specific IgE, total IgE and urine protein electrophoresis (UE)) and the impact of each on test activity volumes.…”

Characteristics promoting behaviour change: physician experience with a coalition-led quality improvement initiative to reduce excessive laboratory test ordering

“…Aimed at identifying key intervention components to reduce daily laboratory test ordering and BUN testing, a coalition-supported, physician-led multicomponent laboratory test ordering overuse initiative was developed. 20 The success of these projects in reducing BUN ordering in hospital medicine units 21 led to the December 2019 approval of a provincial initiative to reduce BUN ordering in hospital medicine units and emergency departments, with plans to continue in one Edmonton-health zone hospital and expand to three hospitals in Alberta’s Central, South and North health zones.…”

Stopping routine urine screening studies for stroke rehabilitation inpatient admissions

“…The secondary aim of this project was to draw attention to standardised order form design and to demonstrate the potential negative influence on physician ordering behaviours. 13 Although standardised forms improve time efficiency and make orders easier to read, these forms have directly influenced physician ordering behaviour for many years resulting in both a financial cost to the system and unnecessary testing. From our health provider survey, participants identified that patient care had not been impacted negatively and no adverse outcomes were identified.…”