BACKGROUND: Improving the appropriateness of testing behavior and reducing the number of laboratory tests have been recognized as essential parts of quality improvement. OBJECTIVE: To assess the effectiveness of an administrative and a short-term educational intervention aimed at reducing clinical biochemistry laboratory utilization. DESIGN: An analysis comparing utilization of laboratory tests performed on in-patients before and after the intervention. SETTING: Computerized database of all laboratory tests performed in Hadassah Ein Kerem Medical Center, Jerusalem, Israel during 1999-2003. INTERVENTION: The administrative intervention included restricting available emergency laboratory tests and frequency of repeated orders. The educational measures included: discussion of the misuse of laboratory tests and its consequences with the hospital medical staff, and presentation of the new restrictive policy. A feedback of the intervention's results was sent to the wards and reviewed with senior medical staff. MAIN OUTCOME MEASURES: Change in utilization (measured as rates per 100 hospital days) of clinical biochemistry tests by hospital division and by selected laboratory tests. RESULTS: An overall reduction of 19% in laboratory tests (95% CI: 18.8-19.2%) was observed in the year after the intervention. Utilization decreased significantly in all the hospital's medical divisions, within a range of 14.9-43.8%. During the intervention period, utilization of hematology tests was reduced by 7.6% (P = 0.009). Statistically significant reductions were noted in the ordering of all 12 selected clinical biochemistry tests. Although the orders of total cholesterol decreased by 72.2%, the utilization of 'high-volume' tests, such as glucose and electrolytes, showed only a modest decrease (7.9% and 6.9%, respectively). CONCLUSIONS: The present study included all hospital medical staff and covered all the available clinical biochemistry tests. This rather simple and low-cost intervention resulted in significant reductions in clinical biochemistry test orders as well as in the ordering of hematological blood tests.
BACKGROUND: Improving the appropriateness of testing behavior and reducing the number of laboratory tests have been recognized as essential parts of quality improvement. OBJECTIVE: To assess the effectiveness of an administrative and a short-term educational intervention aimed at reducing clinical biochemistry laboratory utilization. DESIGN: An analysis comparing utilization of laboratory tests performed on in-patients before and after the intervention. SETTING: Computerized database of all laboratory tests performed in Hadassah Ein Kerem Medical Center, Jerusalem, Israel during 1999-2003. INTERVENTION: The administrative intervention included restricting available emergency laboratory tests and frequency of repeated orders. The educational measures included: discussion of the misuse of laboratory tests and its consequences with the hospital medical staff, and presentation of the new restrictive policy. A feedback of the intervention's results was sent to the wards and reviewed with senior medical staff. MAIN OUTCOME MEASURES: Change in utilization (measured as rates per 100 hospital days) of clinical biochemistry tests by hospital division and by selected laboratory tests. RESULTS: An overall reduction of 19% in laboratory tests (95% CI: 18.8-19.2%) was observed in the year after the intervention. Utilization decreased significantly in all the hospital's medical divisions, within a range of 14.9-43.8%. During the intervention period, utilization of hematology tests was reduced by 7.6% (P = 0.009). Statistically significant reductions were noted in the ordering of all 12 selected clinical biochemistry tests. Although the orders of total cholesterol decreased by 72.2%, the utilization of 'high-volume' tests, such as glucose and electrolytes, showed only a modest decrease (7.9% and 6.9%, respectively). CONCLUSIONS: The present study included all hospital medical staff and covered all the available clinical biochemistry tests. This rather simple and low-cost intervention resulted in significant reductions in clinical biochemistry test orders as well as in the ordering of hematological blood tests.
Authors: Josep Maria Vilaseca Llobet; Laura Costas Caudet; Manuel Martí-Recober; Antoni Trilla García Journal: Aten Primaria Date: 2009-11-07 Impact factor: 1.137
Authors: Daniel M Horn; Kate E Koplan; Margaret D Senese; E John Orav; Thomas D Sequist Journal: J Gen Intern Med Date: 2013-11-21 Impact factor: 5.128
Authors: Claude A Beaty; Kara A Haggerty; Madeline G Moser; Timothy J George; Chase W Robinson; George J Arnaoutakis; Glenn J Whitman Journal: Ann Thorac Surg Date: 2013-09-12 Impact factor: 4.330
Authors: Marc R Larochelle; Amy M Knight; Hardin Pantle; Stefan Riedel; Jeffrey C Trost Journal: J Gen Intern Med Date: 2014-06-28 Impact factor: 5.128