Inappropriate requests of viral hepatitis serologic tests

Ağca, Harun

doi:10.5799/ahinjs.01.2012.02.0140

Cited by 4 publications

(5 citation statements)

References 24 publications

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“…10 Another Turkish study from Tavşanlı General Hospital demonstrated that in a 2-year period, 1,452 anti-HAV IgM tests, 1,452 anti-HAV total tests, 208 anti-HBs tests, 208 anti-HBc total tests, 1,210 anti-HBc IgM tests, 1,358 HBeAg tests, and 1,216 anti-HBe tests were requested inappropriately. 7 To our knowledge, no similar US studies investigating the impact of inappropriate hepatitis testing have been published.…”

Section: Discussionmentioning

confidence: 99%

“…However, no uniform definitions exist for the classification of aminotransferase elevations, as different reviews use different cutoff points. 4 - 7 Patients with marked increases in aminotransferase levels (>10 times the upper reference limit) typically have an acute liver injury. However, data from a series of patients with acute liver injury as a result of viral hepatitis suggest that the most sensitive and specific aminotransferase threshold level to identify acute injury lies within the moderate range of increase (5 to 10 times the upper reference limit, at 200 U/L for AST [sensitivity 91%, specificity 95%] and 300 U/L for ALT [sensitivity 96%, specificity 94%]).…”

Section: Discussionmentioning

confidence: 99%

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Inappropriate Testing for Acute Viral Hepatitis Is Common—Impact of an Intervention Using the Electronic Health Record in a Tertiary Teaching Hospital in the United States

Hammami

Hussaini

Chhaparia

et al. 2020

TOJ

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Background: Unnecessary laboratory tests contribute to the financial burden placed on hospitals, patients, insurers, and taxpayers. In our institution, we noted acute viral hepatitis serologic testing in patients with chronic liver disease, sometimes done repetitively, in the absence of substantially elevated aminotransferase levels. The goal of this study was to determine the frequency of unnecessary testing for acute hepatitis A and B infections and then reduce testing rates by implementing an intervention in the electronic health record. Methods: In a 2-year period, 2 successive interventions questioning the appropriateness of ordering viral hepatitis serology based on transaminase elevation and prior serology results were implemented in the electronic health record system at Saint Louis University Hospital. The first intervention allowed providers to override the warning without providing a reason; the second intervention required justification to proceed with the order. Preintervention and postintervention appropriate and inappropriate testing proportions were compared using Fisher exact test. Results: The electronic reminders resulted in a statistically significant reduction of inappropriate testing rates; however, testing rates remained high whether the provider had to justify overriding the automatic alert or not. Conclusion: Our research demonstrated that the rates of inappropriate testing for acute viral hepatitis at our institution were unnecessarily high and showed that a simple intervention in the medical record system may be useful in reducing inappropriate testing. Our interventions were feasible and implemented at minimal cost. Similar interventions could be used to target other unnecessary tests, but education and additional interventions will likely be required to reduce unnecessary testing further.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Inappropriate Testing for Acute Viral Hepatitis Is Common—Impact of an Intervention Using the Electronic Health Record in a Tertiary Teaching Hospital in the United States

Hammami

Hussaini

Chhaparia

et al. 2020

TOJ

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“…132 This spatial arrangement, in which a town of free blacks stood at some remove from the main fort and the separate Indian pueblos, had precedents in Florida as well. Guatemala's leading royal accountant, Tomas Wading, wrote of the "great advantage" in having San Jose de los Negros located at the edge of Lake Peten, noting that in case of an "enemy invasion" the maroons would provide critical aid in die province's defense.…”

Section: Fleeting Contact In El Montementioning

confidence: 99%

Black Belizeans and Fugitive Mayas: Interracial Encounters on the Edge of Empire, 1750–1803

Lentz

2014

Americas (Washington, 1944)

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and Testimonio del Expediente del comun del Peten, AGI, Estado 49, No. 74, Cuad. 2, 1800, fols. 4v-5. Since Peten's priests, including don Santiago Xavier Rebolledo of San Andres, officiated at the marriages of bozales (African-born blacks) and Maya women, ecclesiastical complaints were more muted than those of the commander and the cacique.4. San Jose and San Jose de los Negros, although in close proximity, were distinct pueblos.

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“…Thus, the physician may not request the tests again (5). Another technique for preventing duplicate tests is organizing education about diagnostic algorithms for health professionals (4). Also, if the patient is infected with hepatitis B or C virus, this information can be saved on hospital network systems.…”

Section: Dear Editor;mentioning

confidence: 99%

An Important Financial Burden: Unnecessary Test Requests for Viral Hepatitis

Karacaer¹

2016

vhd

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Cost-effective approaches for using limited financial resources correctly are essential in the healthcare field. Life expectancy has been increasing in developed and developing countries, and nowadays, acute and chronic diseases are being treated with processes that are becoming more expensive. Consequently, increasing pressure on the health budgets of countries around the world is now a reality. The health expenditure percentage of the gross domestic product is expected to climb in future years (1).To decrease this health expenditure, initially, misapplications in health care should be detected. An article by Demiray et al. (2) in the recent issue of the Viral Hepatitis Journal emphasized the costs of unnecessary tests, and provided beneficial information on this subject for clinicians.Unnecessary test requests for viral hepatitis, in particular, are a significant problem in various centers in Turkey. Alpay Ozbek et al. (3) found that 14% of anti-hepatitis A virus total tests and 18% of (anti-HBc) tests were unnecessarily repeated over a three-year period at a university hospital. The rate of inappropriate tests used for the diagnosis of hepatitis A infection was 52.2% in a two-year study at a state hospital. At this same hospital, it was detected that 12.9% of anti-HBs, 12.9% of anti-HBc total, 74.8% of anti-HBc immunoglobulin M (IgM), 83.9% of hepatitis B envelope antigen (HBeAg), and 75.2% of anti-HBe tests were unnecessary, at a total cost of 56.153 Turkish liras (TL) (4). Genc and Aksu (5) found that the percentages of unnecessary test requests were 2.23% in anti-HBs, 0.7% in anti-HBc total, 37.41% in anti-HBc IgM, 44.86%

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Inappropriate requests of viral hepatitis serologic tests

Cited by 4 publications

References 24 publications

Inappropriate Testing for Acute Viral Hepatitis Is Common—Impact of an Intervention Using the Electronic Health Record in a Tertiary Teaching Hospital in the United States

Inappropriate Testing for Acute Viral Hepatitis Is Common—Impact of an Intervention Using the Electronic Health Record in a Tertiary Teaching Hospital in the United States

Black Belizeans and Fugitive Mayas: Interracial Encounters on the Edge of Empire, 1750–1803

An Important Financial Burden: Unnecessary Test Requests for Viral Hepatitis

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