Reducing Unnecessary Inpatient Laboratory Testing in a Teaching Hospital

May, Todd A.; Clancy, Mary K.; Critchfield, Jeff; Ebeling, Fern; Enriquez, Anita; Gallagher, Carmel; Genevro, Jim; Kloo, Jay; Lewis, Paul; Smith, R. M.; Ng, Valerie

doi:10.1309/wp59ym73l6cegx2f

Cited by 101 publications

(56 citation statements)

References 22 publications

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“…Although a detailed appraisal is beyond the scope of this paper, it is worth noting that the implementation of demand management initiatives has often proved challenging and yielded variable success. 16,17 In summary, we found a wide variability in test request rates between practices that appear unrelated to disease prevalence or crude clinical outcome indicators. This suggests that despite the availability of good-quality clinical guidelines, there is still wide variation in testing practice that appears unrelated to clinical need or outcomes and may reflect instead differences in behaviour by individual clinicians when managing similar clinical problems…”

Section: -11mentioning

confidence: 77%

Clinical outcome indicators, disease prevalence and test request variability in primary care

O’Kane

Casey²,

Lynch

et al. 2011

Ann Clin Biochem

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Aim: To describe differences in biochemistry test request rates (adjusted for practice size) between general practices and to investigate whether differences in HbA 1c and thyroid function test request rates are related either to the practice prevalence of hypothyroidism and diabetes or to Quality and Outcome Framework (QOF) scores. Methods: Information on test request rates, prevalence of diabetes and hypothyroidism, and QOF data over a one-year period were obtained from 58 practices covering a population of 284,609 patients. Spearman's rank correlation tests were used to investigate relationships between adjusted test request rates. Results: There was wide variability in adjusted test request rates (lowest for HbA 1c and highest for immunoglobulins). The ranking of practices for different tests was highly correlated. There was no relationship between adjusted test request rates for HbA 1c and thyroid function and the reported prevalence of diabetes and hypothyroidism, respectively, nor was there any relationship with QOF scores in diabetes and hypothyroidism. Conclusions: There is wide variability in test request rates in general practice that do not appear to be related to disease prevalence or crude clinical outcome measures. 2011; 48: 155-158. Ann Clin Biochem

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Section: -11mentioning

confidence: 77%

Clinical outcome indicators, disease prevalence and test request variability in primary care

O’Kane

Casey²,

Lynch

et al. 2011

Ann Clin Biochem

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“…There are growing calls for physicians to factor the financial consequences into their medical decisions. [28][29][30] Charge data offers additional information for physicians to make the most educated decisions for a patient's care.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Charge Display on Cost of Care and Physician Practice Behaviors: A Systematic Review

Rotman

Hartoularos

et al. 2015

J GEN INTERN MED

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BACKGROUND: While studies have been published in the last 30 years that examine the effect of charge display during physician decision-making, no analysis or synthesis of these studies has been conducted. OBJECTIVE: We aimed to determine the type and quality of charge display studies that have been published; to synthe-size this information in the form of a literature review. METHODS: English-language articles published between 1982 and 2013 were identified using MEDLINE, Web of Knowledge, ABI-Inform, and Academic Search Premier. Article titles, abstracts, and text were reviewed for relevancy by two authors. Data were then extracted and subsequently synthesized and analyzed. RESULTS: Seventeen articles were identified that fell into two topic categories: the effect of charge display on radiology and laboratory test ordering versus on medication choice. Seven articles were randomized controlled trials, eight were pre-intervention vs. post-intervention studies, and two interventions had a concurrent control and intervention groups, but were not randomized. Twelve studies were conducted in a clinical environment, whereas five were survey studies. Of the nine clinically based interventions that examined test ordering, seven had statistically significant reductions in cost and/or the number of tests ordered. Two of the three clinical studies looking at medication expenditures found significant reductions in cost. In the survey studies, physicians consistently chose fewer tests or lower cost options in the theoretical scenarios presented. CONCLUSIONS: In the majority of studies, charge information changed ordering and prescribing behavior.KEY WORDS: charge display; physician behavior; costs of care.

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“…[10,11] As such, inappropriate tests are most common in teaching hospitals. [12] Junior doctors account for a significant proportion of inappropriate pathology test ordering. [12] This is reinforced at Australian hospitals by a culture where the risk of over-ordering tests is perceived to have less serious consequences than not having ordered a required test.…”

Section: Introductionmentioning

confidence: 99%

“…[12] Junior doctors account for a significant proportion of inappropriate pathology test ordering. [12] This is reinforced at Australian hospitals by a culture where the risk of over-ordering tests is perceived to have less serious consequences than not having ordered a required test. [9] It has been identified that within the hospital that in some situations junior nurses are pre-empting the treating doctor's pathology testing, leading to a significant proportion of unnecessary ordering.…”

Section: Introductionmentioning

confidence: 99%

Medical stewardship: Pathology evidence based ordering to reduce inappropriate test ordering in a teaching hospital

Gardiner

2015

JHA

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Objective: This study was designed as an educational program aimed at promoting evidence-based pathology ordering with the aim of reducing inappropriate test ordering. Methods: Researchers benchmarked the hospital's pathology tests ordered in 2013-2014 before conducting a multifaceted education program in 2014-2015. The intervention consisted of main priorities including pathology test auditing, in-services and lectures, development and implementation of investigation pathways, and policy and procedure compliance. The main outcome measures was a reduction in commonly inappropriate ordered pathology testing leading to a reduction in the average test per hospital admission, and a reduction in specimen collection errors. Results: Through this educational method the researchers achieved a reduction in the average test per admission in 2014-2015 (M = 12.98) from 2013-2014 (M = 13.83). A two sample t-test indicated that this difference was significant, t(3.3006) = 0.0071, p = .01. The intervention included a focus on specimen collection errors and achieved a reduction in specimen error rates (M = 2,695) from the previous year (M = 3,000). A one sample t-test indicated that this difference was significant, t(3.0804) = 0.0105, p = .05. This intervention decreased commonly inappropriate pathology requests of Full Blood Count (FBC, -4.21%), Liver Function Tests (LFTs, -8.36%), Vitamin B12 (B12, -6.45%) and Coagulation profile (-21.22%). Commonly inappropriate pathology tests decreased (M = 7,120.33) from (M = 7,609.67). A two sample t-test indicated that this difference was significant, t(3.7730) = 0.0031, p = .005. Conclusions: Results confirmed that a multi-faceted education program can reduce inappropriate pathology test ordering, commonly over-ordered pathology test ordering, and pathology specimen error rates while maintaining positive patient outcomes.

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Reducing Unnecessary Inpatient Laboratory Testing in a Teaching Hospital

Cited by 101 publications

References 22 publications

Clinical outcome indicators, disease prevalence and test request variability in primary care

Clinical outcome indicators, disease prevalence and test request variability in primary care

The Effect of Charge Display on Cost of Care and Physician Practice Behaviors: A Systematic Review

Medical stewardship: Pathology evidence based ordering to reduce inappropriate test ordering in a teaching hospital

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