Reducing Unnecessary Inpatient Laboratory Testing in a Teaching Hospital

Abstract

After an inpatient phlebotomy-laboratory test request audit for 2 general inpatient wards identified 5 tests commonly ordered on a recurring basis, a multidisciplinary committee developed a proposal to minimize unnecessary phlebotomies and laboratory tests by reconfiguring the electronic order function to limit phlebotomy-laboratory test requests to occur singly or to recur within one 24-hour window. The proposal was implemented in June 2003. Comparison of fiscal year volume data from before (2002-2003) and after (2003-2004) implementation revealed 72,639 (12.0%) fewer inpatient tests, of which 41,765 (57.5%) were related directly to decreases in the 5 tests frequently ordered on a recurring basis. Because the electronic order function changes did not completely eliminate unnecessary testing, we concluded that the decrease in inpatient testing represented a minimum amount of unnecessary inpatient laboratory tests. We also observed 17,207 (21.4%) fewer inpatient phlebotomies, a decrease sustained in fiscal year 20042005. Labor savings allowed us to redirect phlebotomists to our understaffed outpatient phlebotomy service.

Reducing unnecessary testing: an intervention to improve resident ordering practices

“…In this case, tests may not be reassessed daily to determine whether they are truly needed. Because our study showed that education and cost awareness were not sufficient to change this ordering practice in residents, an alternative solution could be to modify the ordering system to have an expiration date 8 18. A second explanation is the fact that most ordering in our teaching services is done by interns.…”

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

“…Previous studies employing educational interventions to alter clinical behaviour have noted that the long-term effects of any single intervention are often disappointing [2,3,5,6]. Consistent with this, after a few weeks, the rate of pathology testing returned towards baseline rates.…”

“…In the hospital setting, most test ordering is by junior doctors [6]. There is thus considerable support for strategies targeted at junior medical officers (JMOs) in their first 2 years after graduation, which is recognised as a critical period of training and education [4].…”

“…Such strategies could include restrictions on the range of tests that JMOs may request, an approach found to be valuable in settings such as emergency departments [7,8]. Several reports have suggested that education, audit and feedback are also useful in managing the demand for pathology laboratory tests [2,3,5,6]. However, others have stated that educational interventions only moderately influence test-requesting behaviour, arguing instead for computerised laboratory management systems and budgetary controls [9].…”

Reducing Unnecessary Laboratory Testing Using Health Informatics Applications: A Case Study on a Tertiary Care Hospital

“…We need to set standards for the proper testing and the proper frequency of repeating tests, depending on the specialty of medicine and also on the patient's clinical condition and case severity [13]. Then we need to go through suggesting and planning different approaches and methodologies to manage these unnecessary tests, mainly by using health informatics applications and clinical decision support systems, and finally we need to implement such methodologies and measure their short-term as well as long term results in the form of achievable reduction of such tests [14].…”