Variation in Diagnostic Testing in ICUs

Spence, Jessica; Bell, Dean D.; Garland, Allan

doi:10.1097/ccm.0b013e3182a63887

Cited by 16 publications

(2 citation statements)

References 34 publications

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“…In tertiary care teaching institutions, gastroenterological care is provided through GI consults, typically performed by GI fellowship trainees as they learn the essentials of functioning as a gastroenterology consultant. The learning environment has the potential to generate a higher number of tests ordered compared to practicing gastroenterologists, similar to that reported for ICU patients [4]. However, the volume of tests ordered by a GI teaching service is not known.…”

Section: Introductionmentioning

confidence: 81%

Do Consultants Follow Up on Tests They Recommend? Insights from an Academic Inpatient Gastrointestinal Consult Service

et al. 2017

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Background Inpatient care is a fundamental part of gastroenterology training and involves the recommendation, performance, and interpretation of diagnostic tests. However, test results are not always communicated to patients or treating providers. We determined the process of communication of test results and recommendations in our inpatient gastroenterology (GI) consult service. Methods Test recommendations on 304 consecutive new GI consults (age 60.2 ± 1.0 year) over a 2-month period were recorded. Demographic factors (age, race, gender, zip code, insurance status) were extracted from the electronic medical record (EMR). Charts were independently reviewed 6 months later to determine results of recommended tests, follow-up of actionable test results, 30-day readmission rates, and predictors of suboptimal communication. Results Of 490 recommended tests, 437 (89.2%) were performed, and 199 (45.5%) had actionable findings. Of these, 48 (24.1%) did not have documented follow-up. Failure of follow-up was higher for upper endoscopy (31.9%) compared to colonoscopy (18.0%, p = 0.07). Women (p = 0.07), patients on Medicare (p = 0.05), and procedures supervised by advanced GI fellows (p = 0.06) were less likely to receive follow-up. Median income and identification of a primary provider did not influence follow-up rates; 30-day readmission rates were not impacted. Female gender, insurance (Medicare) status, and attending type remained independent predictors of failure of follow-up on multivariate regression (p ≤ 0.03). Conclusions Failure to follow up test results on inpatient services at a large academic center was unacceptably high. Maximizing personnel participation together with diligence and technology (EMR) will be required to improve communication.

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Section: Introductionmentioning

confidence: 81%

Do Consultants Follow Up on Tests They Recommend? Insights from an Academic Inpatient Gastrointestinal Consult Service

et al. 2017

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“…Few projects have targeted variation in pathology testing. Although there have been some studies indicating a high level of variation in pathology test ordering practices [13][14][15] in acute care hospitals, there is currently limited research identifying, measuring and remediating variation in the use of pathology tests, particularly in the emergency department (ED). A recent Australian study revealed significant variation in test ordering across EDs, with some EDs ordering consistently more tests that were not in line with best practice guidelines.…”

Section: Introductionmentioning

confidence: 99%

Evaluating the long-term effects of a data-driven approach to reduce variation in emergency department pathology investigations: study protocol for evaluation of the NSW Health Pathology Atlas of variation

et al. 2020

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IntroductionVariation in test ordering is a major issue in Australia and globally with significant financial and clinical impacts. There is currently a lack of research identifying and remediating variation in the use of pathology tests in emergency departments (EDs). In 2019, NSW Health Pathology introduced the Pathology Atlas of Variation that uses a data-driven tool (the Atlas Analytical Model) to investigate test order variation across New South Wales (NSW) and engage with local health districts (LHDs) to reduce variation. The objectives of this study are to evaluate whether this data-driven approach is associated with: (1) a reduction in test order variation; (2) improvements in patient outcomes and (3) cost benefits, for the five most frequent ED presentations.Methods and analysisThis is a large multisite study including 45 major public hospitals across 15 LHDs in NSW, Australia. The Atlas Analytical Model is a data analytics and visualisation tool capable of providing analytical insights into variation in pathology investigations across NSW EDs, which will be used as feedback to inform LHDs efforts to reduce variation. Interrupted time series analyses using 2 years pre Atlas (2017–2018) and 2 years post Atlas (2021–2022) data will be conducted. Study data will be obtained by linking hospital and laboratory databases. Funnel plots will be used to identify EDs with outlying pathology test ordering practices. The outcome measures include changes in test ordering practices, ED length of stay, hospital admission and cost benefits (total pathology costs per ED encounter).Ethics and disseminationThe study has received ethical approval from the NSW Population and Health Service Research Ethics Committee (reference, 2019/ETH00184). The findings of the study will be published in peer-reviewed journals and disseminated via presentations at conferences. We will also engage directly with key stakeholders to disseminate the findings and to inform policies related to pathology testing in the ED.

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Predictors of intraoperative testing in adults undergoing noncardiac surgery within a regional hospital system

Spence

Troncone

Long

et al. 2017

Can J Anesth/J Can Anesth

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Intraoperative testing is common and more likely in patients undergoing high-risk surgical procedures. In a central laboratory system, there is substantial time from ordering the tests to receiving the results. The clinical impact of this delay is unknown. Further evaluation is required regarding the relationship between the time required for intraoperative test results and perioperative outcomes.

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Variation in Diagnostic Testing in ICUs

Cited by 16 publications

References 34 publications

Do Consultants Follow Up on Tests They Recommend? Insights from an Academic Inpatient Gastrointestinal Consult Service

Do Consultants Follow Up on Tests They Recommend? Insights from an Academic Inpatient Gastrointestinal Consult Service

Evaluating the long-term effects of a data-driven approach to reduce variation in emergency department pathology investigations: study protocol for evaluation of the NSW Health Pathology Atlas of variation

Predictors of intraoperative testing in adults undergoing noncardiac surgery within a regional hospital system

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