Use of Laboratory Tests in a Teaching Hospital: Long-Term Trends

Griner, Paul F.

doi:10.7326/0003-4819-90-2-243

Cited by 98 publications

(28 citation statements)

References 4 publications

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“…Educational and administrative strategies in teaching hospitals can drastically reduce the use of subsidiary examination, with less discomfort for the patient, no impairment of care and with an important reduction of expenses 30,31 . Thurow reported that in The United States there is a great preoccupation with the growing expenses in health and thinks that this problem needs to be solved more in an ethical than in an economical way 32 .…”

Section: Discussionmentioning

confidence: 99%

The diagnosis of delirium in 80 emergency unit patients

Neves

Sesso

Ferraz

et al. 1998

Arq. Neuro-Psiquiatr.

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-We evaluated the initial and final diagnosis of 80 patients with delirium arriving at the emergence unit of a university hospital in a large Brazilian city over a period of 30 months up to December 1991. The diagnosis was based on the DSM-IIIR criteria. Patients with a known history of head trauma or epileptic seizure and patients younger than 13 years were excluded. Only patients with a disease of up to 7 days were included.The patients were subdivided into four etiologic groups: vascular; associated with the use of alcohol; infectiousparasitic; miscellaneous.The results showed a rate of correct diagnosis ranging from 65 to 80% with the use of kappa test (standard good to excelent). Sensitivity, specificity, positive predictive and negative predictive values had results showing different conditions for initial diagnosis in each group. This study can help the initial diagnosis of delirium and the choice for diagnostic testing.KEY WORDS: delirium, diagnosis, acute confusional state. Delirium is a quite common syndrome but is often underestimated. The synonymy of this disease includes about thirty other terms. The first scientific description of delirium was probably made by Hippocrates. He used the word phrenitis, derived from phrenes, a word used to mean mind and also the muscle diaphragm. The word delirium was first used by Celsius, in the first century before Christ 1 . Great progress in the knowledge of acquired cognitive disturbances was first made in the nineteenth century. The linkage between brain and behavior was assumed to exist in a modern scientific meaning after the description of a left brain lesion associated with aphasia by Broca. Description of neurosyphilis, Huntington's chorea and Pick's disease were made by other authors. In 1906, Alzheimer described signs of neuronal degeneration in the brain of a woman with a progressive memory disorder 2 . Diagnóstico de delirium em 80 pacientes atendidos no pronto socorro

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Section: Discussionmentioning

confidence: 99%

The diagnosis of delirium in 80 emergency unit patients

Neves

Sesso

Ferraz

et al. 1998

Arq. Neuro-Psiquiatr.

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“…We limit our discussion here to physician-oriented interventions, recognizing that larger issues of reimbursement policies, efficiency of labo ratory services, and cost-effectiveness of laboratory tests also play major parts in the problems associated with low-cost diagnostic tests (3,37,45). Griner reported in 1979 the results of a sustained, multipronged effort to improve laboratory utilization in a teaching hospital (30). The median number of chemistry tests per hospitalized patient (counting an automated battery as a single test) fell from 18 in 1970 to 13 in 1977.…”

Section: Interventions To Improve Use Of Clinical Chemistriesmentioning

confidence: 99%

“…Many possible explanations for overuse of laboratory tests have been ad vanced (3,30). Among these are the following.…”

Section: Reasons Fo R Overusementioning

confidence: 99%

Low-Cost Medical Practices

Fineberg¹,

Pearlman²

1982

Annu. Rev. Public Health

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“…A multitude of factors contributing to excessive laboratory test utilization has been described in the literature (1,35,49 (11,64,72 (50). It has been noted that a "blanket requester" who orders unnecessary tests may reduce inpatient length of stay and costs compared with the "traditional selector," who reviews initial diagnostic test results before selecting additional studies (60).…”

Section: Increase In Laboratory Test Utilization Increasing Laboratormentioning

confidence: 99%

“…Expenses are accrued for activities other than the pursuit of new knowledge. Some university teaching centers emphasize complete patient workups, and the house officer must submit to teacher demands (35,39,49). Other residents believe that their peers or teachers will be impressed if all possible testing has been performed (39).…”

Section: Physician Education Role In Increased Laboratory Testingmentioning

confidence: 99%

Rationale for cost-effective laboratory medicine

Robinson

1994

Clin Microbiol Rev

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There is virtually universal consensus that the health care system in the United States is too expensive and that costs need to be limited. Similar to health care costs in general, clinical laboratory expenditures have increased rapidly as a result of increased utilization and inflationary trends within the national economy. Economic constraints require that a compromise be reached between individual welfare and limited societal resources. Public pressure and changing health care needs have precipitated both subtle and radical laboratory changes to more effectively use allocated resources. Responsibility for excessive laboratory use can be assigned primarily to the following four groups: practicing physicians, physicians in training, patients, and the clinical laboratory. The strategies to contain escalating health care costs have ranged from individualized physician education programs to government intervention. Laboratories have responded to the fiscal restraints imposed by prospective payment systems by attempting to reduce operational costs without adversely impacting quality. Although cost containment directed at misutilization and overutilization of existing services has conserved resources, to date, an effective cost control mechanism has yet to be identified and successfully implemented on a grand enough scale to significantly impact health care expenditures in the United States.

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Use of Laboratory Tests in a Teaching Hospital: Long-Term Trends

Cited by 98 publications

References 4 publications

The diagnosis of delirium in 80 emergency unit patients

The diagnosis of delirium in 80 emergency unit patients

Low-Cost Medical Practices

Rationale for cost-effective laboratory medicine

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