Cessation of dipstick urinalysis reflex testing and physician ordering behavior.

The purpose of our study was to determine the effect of the elimination of laboratory-initiated reflex testing on physician ordering behavior. In 1999, we stopped laboratory-initiated reflex testing and did microscopic analysis only on physician request. The number of urinalysis dipstick tests, microscopic analysis tests, and urine cultures done during 6-month periods for the next 10 years was extracted from our laboratory information system that includes data from the middle of 1999. The number of physician complaints was also recorded. Before the intervention, we did 106,000 urine analysis tests per 6-month period, with 19,006 microscopic examinations (17.9%) that decreased to less than 0.2% after the change in policy. During the 10-year period, physician requests for microscopic urinalysis decreased gradually to around 50 in any 6-month period.