Perception of usefulness of laboratory tests ordering by internal medicine residents in ambulatory setting: A single-center prospective cohort study

Abstract

The demand for high value health care uncovered a steady trend in laboratory tests ordering and inappropriate testing practices. Residents’ training in laboratory ordering practice provides an opportunity for quality improvement. We collected information on demographics, the main reason for the appointment, preexisting medical conditions and presence of co-morbidities from first-visit patients to the internal medicine outpatient service of our university general hospital. We also collected information on all laboratory tests ordered by the attending medical residents. At a follow-up visit, we recorded residents’ subjective perception on the usefulness of each ordered laboratory test for the purposes of diagnosis, prognosis, treatment or screening. We observed that 17.3% of all ordered tests had no perceived utility by the attending resident. Tests were usually ordered to exclude differential diagnoses (26.7%) and to help prognosis estimation (19.1%). Age and co-morbidity influenced the chosen category to legitimate usefulness of tests ordering. This study suggests that clinical objectives (diagnosis, prognosis, treatment or prevention) as well as personalization to age and previous health conditions should be considered before test ordering to allow a more appropriate laboratory tests ordering, but further studies are necessary to examine this framework beyond this medical training scenario.

Reducing routine inpatient blood testing

“…Routine, repetitive ordering of blood tests in hospital inpatients without clinical indications is a practice primarily enabled by healthcare providers. These tests are often ordered with the intent of excluding a diagnosis, helping with prognostication, or enhancing patient safety 4041. Similar to other types of low value care, this practice is driven by clinician habits, institutional culture, fear of litigation, and perceived pressure from families and caregivers 40.…”

An Integrated Management System for a Medical Center

“…When it comes to illness diagnosis and prognosis, similarly to in hazard stratification, treatment preference and evaluation of the reaction to it, and observation of the reason of disease, laboratory tests playing an important auxiliary role. [13] According to the proposed software product on medical center management, laboratory management was one of the main functions. The current system in the laboratory management use a manual paper-based system.…”