The Appropriateness of Routine Diagnostic Studies

Abstract

This paper reports a survey of routine admission and preoperative diagnostic studies required by regulation at fifteen USAF hospitals. The results show that each hospital differs from the others on studies required. Clinical reports show that routine diagnostic studies are inappropriate on hospital admission. Clinical investigation has found that for preoperative patients a routine hemoglobin or hematocrit is indicated over age 60 years, an electrocardiogram over age 40 to 55, and a chest X-ray over age 60 to 70. The consensus of investigators is that diagnostic studies should be performed only when clinically indicated. Military hospitals could realize a substantial cost savings by not requiring unindicated diagnostic studies.

Routine preoperative testing: a systematic review of the evidence.

“…13 Nonetheless, wide variation in the use of preoperative chest X-ray has remained, both between hospitals and between specialties within the same hospital. [14][15][16][17] Purposes of routine preoperative chest X-ray…”

“…Despite attempts to define more limited indications for preoperative electrocardiography considerable variation between specialties and hospitals persists, 14,16,17 as was found for chest X-ray (see chapter 3).…”

Cost‐effective management of colon and rectal cancer

“…They estimated that in one hospital 9,000 tests could be avoided, with a savings of $95,800 annually. In a similar study Romfh [45] estimated that up to $330,000 could be saved in 15 military hospitals by eliminating unindicated tests. Routine tests that have been shown to be unnecessary except when clinically indicated include electrocardiograms [46], test of hemostatic function [44,45,47], biochemistry panels [44,46], urinalyses [48,49], and intravenous pyelograms [50,51].…”

“…In a similar study Romfh [45] estimated that up to $330,000 could be saved in 15 military hospitals by eliminating unindicated tests. Routine tests that have been shown to be unnecessary except when clinically indicated include electrocardiograms [46], test of hemostatic function [44,45,47], biochemistry panels [44,46], urinalyses [48,49], and intravenous pyelograms [50,51]. Physicians must ask what they will learn from a given test, whether there is a simpler, less expensive way to learn the same thing and whether that knowledge will alter the approach to the patient.…”

How Much Routine Preoperative Laboratory Testing Is Enough?

“…The practice of routine laboratory testing for hospitalized patients has received much scrutiny (15)(16)(17). Each commonly used &dquo;routine&dquo; test will be discussed.…”