Abstract
Clinical guidelines and a weekly review of medical records were introduced into a medical unit in a teaching hospital to promote a more discriminating use of laboratory tests. This strategy resulted in an immediate reduction in the average number of requests each week from 74 to 27 haematological tests (64%) and 158 to 58 biochemical tests (64%). During a period of 10 weeks after the strategy was introduced (the intervention period) the mean number of haematological tests for each person decreased from 2.0 during the baseline period to 1.1 (45% reduction; p less than 0.01) and the mean number of biochemical tests decreased from 4.4 to 2.7 (39%; p less than 0.0001). The decrease in the number of repeat requests was greater than that for new requests and accounted for half the reduction in use. There was no significant change in the number of tests requested from an adjacent medical unit that was not exposed to the interventions. This strategy is worthy of trial in other specialties and hospitals, but attention will have to be paid to possible difficulties in sustaining reductions in use over long periods of time.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Ashley J. S., Pasker P., Beresford J. C. How much clinical investigation? Lancet. 1972 Apr 22;1(7756):890–892. doi: 10.1016/s0140-6736(72)90752-0. [DOI] [PubMed] [Google Scholar]
- Cordon I. W. Skull roentgenography for patients with head trauma: the use of high-yield criteria. Can Med Assoc J. 1981 Mar 1;124(5):584–589. [PMC free article] [PubMed] [Google Scholar]
- Cummins R. O., LoGerfo J. P., Inui T. S., Weiss N. S. High-yield referral criteria for posttraumatic skull roentgenography. Response of physicians and accuracy of criteria. JAMA. 1980 Aug 15;244(7):673–676. [PubMed] [Google Scholar]
- Daniels M., Schroeder S. A. Variation among physicians in use of laboratory tests. II. Relation to clinical productivity and outcomes of care. Med Care. 1977 Jun;15(6):482–487. doi: 10.1097/00005650-197706000-00004. [DOI] [PubMed] [Google Scholar]
- Fleming P. R., Zilva J. F. Work-loads in chemical pathology: too many tests? Health Trends. 1981 May;13(2):46–49. [PubMed] [Google Scholar]
- Fleming P. R., Zilva J. F. Work-loads in chemical pathology: too many tests? Health Trends. 1981 May;13(2):46–49. [PubMed] [Google Scholar]
- Fowkes F. G., Evans R. C., Williams L. A., Gehlbach S. H., Cooke B. R., Roberts C. J. Implementation of guidelines for the use of skull radiographs in patients with head injuries. Lancet. 1984 Oct 6;2(8406):795–796. doi: 10.1016/s0140-6736(84)90715-3. [DOI] [PubMed] [Google Scholar]
- Grossman R. M. A review of physician cost-containment strategies for laboratory testing. Med Care. 1983 Aug;21(8):783–802. doi: 10.1097/00005650-198308000-00003. [DOI] [PubMed] [Google Scholar]
- Hampton J. R., Harrison M. J., Mitchell J. R., Prichard J. S., Seymour C. Relative contributions of history-taking, physical examination, and laboratory investigation to diagnosis and management of medical outpatients. Br Med J. 1975 May 31;2(5969):486–489. doi: 10.1136/bmj.2.5969.486. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Manic states in affective disorders of childhood and adolescence. Br Med J. 1979 Jan 27;1(6158):214–215. doi: 10.1136/bmj.1.6158.214. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Martin A. R., Wolf M. A., Thibodeau L. A., Dzau V., Braunwald E. A trial of two strategies to modify the test-ordering behavior of medical residents. N Engl J Med. 1980 Dec 4;303(23):1330–1336. doi: 10.1056/NEJM198012043032304. [DOI] [PubMed] [Google Scholar]
- Roberts C. J. The effective use of diagnostic radiology. J R Coll Physicians Lond. 1984 Jan;18(1):62–65. [PMC free article] [PubMed] [Google Scholar]
- Stilwell J. A., Young D., Cunnington A. Evaluation of laboratory tests in hospitals. Ann Clin Biochem. 1980 Nov;17(6):281–286. doi: 10.1177/000456328001700601. [DOI] [PubMed] [Google Scholar]