Objective While there is concern about excessive laboratory test ordering in the ED, it is difficult to quantify the problem. One solution involves the Mean Abnormal Result Rate (MARR), which is the proportion of tests ordered that return abnormal results. The primary objective of this study was to calculate MARR scores, and factors associated with MARR scores, for tests ordered between April 2014 and March 2019 at adult EDs in Calgary. Methods Administrative data were obtained for 40 laboratory tests that met selection criteria. One possible MARR correlate, physician experience, was quantified for 209 ED physicians as number of years since licensure. Analyses were descriptive where appropriate for whole-population data.
ResultsThe condensed dataset comprised 3,395,312 test results on 415,653 unique patients. The aggregate 5-year MARR score was 40.1%. The highest per-test score was for BNP (80.5%), while the lowest was for glucose (7.9%). MARR scores were higher for nurse-initiated orders than for physician-initiated orders (44.7% vs. 38.1%). The MARR score correlated inversely with number of tests per order (r = − 0.90; 95% confidence interval [CI] − 0.65 to − 0.94; p < 0.001) and directly with physician experience (r = 0.28, 95% CI 0.20 to 0.27; p < 0.001). Conclusion This is the first study to measure MARR scores in an ED setting. While lower scores (close to 5%) are less optimal in principle, ideal scores will depend on the clinical context in which tests are used. However, once departmental benchmarks are established, MARR score-monitoring allows efficient tracking of ordering practices across millions of tests.
Keywords Laboratory testing • Choosing Wisely • Practice variation • Mean abnormal result rate
RésuméObjectifs Bien que l'on s'inquiète d'une commande excessive de tests de laboratoire dans le service d'urgence, il est difficile de quantifier le problème. Une solution implique le taux de résultat anormal moyen (MARR), qui est la proportion de tests commandés qui renvoient des résultats anormaux. L'objectif principal de cette étude était de calculer les scores MARR, et les facteurs associés aux scores MARR, pour les tests commandés entre avril 2014 et mars 2019 dans les services d'urgence pour adultes à Calgary.