Educating Junior Doctors to Reduce Requests for Laboratory Investigations: Opportunities and Challenges

Ritchie, Angus; Jureidini, Elsa; Kumar, Rakesh K.

doi:10.1007/s40670-014-0041-2

Cited by 3 publications

(2 citation statements)

References 9 publications

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“…Most investigations within the hospital system are ordered by junior doctors. It has been previously postulated that the critical period to teach doctors judicious requesting is within the first 2 years of practice . Education, audit and feedback are all effective in teaching; however, given the frequency of rotation through various specialties, it can be difficult to have continuity .…”

Section: Discussionmentioning

confidence: 99%

Comparison of expenditure between an inpatient palliative care unit and tertiary adult medical and surgical wards for patients at end of life: a retrospective chart analysis

Gogna

Broadbent

Baade

2020

Internal Medicine Journal

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Background: The highest healthcare expenditures occur towards the end of life. Costs relate to hospital admissions and investigations to diagnose, prognosticate and direct treatment.Aims: An Australian study to compare the cost of investigations in the last 72 h of life between an inpatient palliative care unit (PCU) and a tertiary hospital. Method:We retrospectively reviewed 50 adult medical and surgical patients (admitted for >72 h and who died in hospital) from the PCU and referring tertiary centre between March and July 2016. Patients in the emergency department, intensive care, medical assessment and paediatric and obstetric units were excluded. All patients had an acute resuscitation plan and were on the 'Care of the Dying' pathway.Results: Expenditure was less if palliative care were the primary caregivers, with statistically significant differences in the amount of imaging (P < 0.001) and pathology (P < 0.001) ordered. There was no difference in microbiology (P = 0.172) and histology (P~1) ordered. Total cost of investigations for PCU patients was $1340.60 (4 of 50 patients) compared with $9467.78 (29 of 50 patients) in the tertiary hospital. PCU patients had longer lengths of stay (15.54 days vs 11.06 days) but cost less per bed day ($868.32 vs $878.79 respectively).Conclusion: Inpatient PCU are less likely to order investigations and are more costeffective. A prospective study comparing an inpatient PCU and patients at a tertiary centre, with and without consult liaison palliative care input, would be worthwhile to see if outcomes remain the same and if consult liaison palliative care affects the investigative burden.

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Section: Discussionmentioning

confidence: 99%

Comparison of expenditure between an inpatient palliative care unit and tertiary adult medical and surgical wards for patients at end of life: a retrospective chart analysis

Gogna

Broadbent

Baade

2020

Internal Medicine Journal

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“…Ritchie et al 4 concluded that encouraging junior doctors to use an e-learning tool such as iNvestigate reduced laboratory test costs by A$66,000 in six clinical departments over a sixweek period in a major tertiary hospital. In a study by Seguin et al 5 , the ordering of blood gas analysis and electrolytes in the ICU was reduced by 22% by providing information about the costs of tests.…”

Section: Introductionmentioning

confidence: 99%

Rational Clinical Pathology Assessment in the Intensive Care Unit

Rachakonda

Parr

Åneman

et al. 2017

Anaesth Intensive Care

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Blood tests are ordered on a daily basis in intensive care units (ICU). There are no widely accepted guidelines for testing requirements. This study investigated the impact on ICU laboratory test costs of a multi-strategy change in practice involving routine blood testing. A single centre, prospective, interventional study using historical controls was undertaken to investigate the impact of ICU specialist authorisation of high-volume routine tests on ICU laboratory test costs. Prior to commencement of the study, ICU nursing and junior ICU doctors were able to order tests. During the six-month intervention period, the ICU specialists authorised routine blood tests. Adverse events related to not performing blood tests were also recorded. Overall ICU laboratory test costs decreased by 12.3% over the six months (P=0.0022 versus historical control) with a mean compliance of 51% with the test authorisation protocol. The costs of frequently ordered tests (classified as high-volume) decreased by 20% (P=0.0022 versus historical control). These accounted for an average of 54 ± 3% of the overall ICU blood test costs (blood gas analyses 17%, simple chemistry tests consisting of electrolytes, liver function, calcium, phosphate, magnesium 14%, coagulation 12% and full blood count 11%). Two protocol-related adverse events were recorded and judged as minor and were resolved by ordering tests during the day. No adverse patient outcomes resulted from these two events. Blood testing authorisation by an ICU specialist was associated with significant cost savings in ICU and no adverse patient outcomes.

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Investigations for the assessment of adult patients presenting to the emergency department with supraventricular tachycardia

Fernando

Adams

Mitra

2020

World Journal of Emergency Medicine

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Patients with supraventricular tachycardia (SVT) commonly present to the emergency department (ED). Current guidelines [1,2] do not recommend routine pathology testing and a report on the topic has questioned their role. A systematic review concluded that troponin testing is commonly performed with a high proportion of positive fi ndings, but these results were not associated with major adverse cardiac events. [3] The conclusions of this review were limited by paucity of data and heterogeneity among studies. Unnecessary and/or inappropriate investigations in the ED have been associated with adverse effects. False-positive results or incidental findings may lead to unnecessary investigation, at the risk of the true pathology being ignored. It is also important with respect to utilisation of resources, particularly in Australia where costs to the health care system are substantially borne by the taxpayer. [4] Evidence-based implementation of protocols for investigations, education program for medical staff and audit/feedback processes have been previously associated with safe and efficient diagnostic practices. [5] Among patients presenting to the ED with SVT, we aimed to describe adjunct investigations and assess whether the results of such investigations influenced management in the ED.

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Educating Junior Doctors to Reduce Requests for Laboratory Investigations: Opportunities and Challenges

Cited by 3 publications

References 9 publications

Comparison of expenditure between an inpatient palliative care unit and tertiary adult medical and surgical wards for patients at end of life: a retrospective chart analysis

Comparison of expenditure between an inpatient palliative care unit and tertiary adult medical and surgical wards for patients at end of life: a retrospective chart analysis

Rational Clinical Pathology Assessment in the Intensive Care Unit

Investigations for the assessment of adult patients presenting to the emergency department with supraventricular tachycardia

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