Giuseppe Lippi1, Marco Brambilla2, Patrizia Bonelli3, Rosalia Aloe3, Antonio Balestrino4, Anna Nardelli5, Gian Paolo Ceda6, Massimo Fabi7. 1. Laboratory of Clinical Chemistry and Hematology, Diagnostic Department, University Hospital of Parma, Parma, Italy. Electronic address: glippi@ao.pr.it. 2. Information System, University Hospital of Parma, Parma, Italy. 3. Laboratory of Clinical Chemistry and Hematology, Diagnostic Department, University Hospital of Parma, Parma, Italy. 4. Medical Direction, University Hospital of Parma, Parma, Italy. 5. Geriatric Unit, Geriatric-Rehabilitation Department, University Hospital of Parma, Parma, Italy. 6. Department of Clinical and Experimental Medicine, Section of Geriatrics, University of Parma, Parma, Italy. 7. General Direction, University Hospital of Parma, Parma, Italy.
Abstract
OBJECTIVES: There is consolidated evidence that the burden of inappropriate laboratory test requests is very high, up to 70%. We describe here the function of a computerized alert system linked to the order entry, designed to limit the number of potentially inappropriate laboratory test requests. DESIGN AND METHODS: A computerized alert system based on re-testing intervals and entailing the generation of pop-up alerts when preset criteria of appropriateness for 15 laboratory tests were violated was implemented in two clinical wards of the University Hospital of Parma. The effectiveness of the system for limiting potentially inappropriate tests was monitored for 6months. RESULTS: Overall, 765/3539 (22%) test requests violated the preset criteria of appropriateness and generated the appearance of electronic alert. After alert appearance, 591 requests were annulled (17% of total tests requested and 77% of tests alerted, respectively). The total number of test requests violating the preset criteria of inappropriateness constantly decreased over time (26% in the first three months of implementation versus 17% in the following period; p<0.001). The total financial saving of test withdrawn was 3387 Euros (12.8% of the total test cost) throughout the study period. CONCLUSIONS: The results of this study suggest that a computerized alert system may be effective to limit the inappropriateness of laboratory test requests, generating significant economic saving and educating physicians to a more efficient use of laboratory resources.
OBJECTIVES: There is consolidated evidence that the burden of inappropriate laboratory test requests is very high, up to 70%. We describe here the function of a computerized alert system linked to the order entry, designed to limit the number of potentially inappropriate laboratory test requests. DESIGN AND METHODS: A computerized alert system based on re-testing intervals and entailing the generation of pop-up alerts when preset criteria of appropriateness for 15 laboratory tests were violated was implemented in two clinical wards of the University Hospital of Parma. The effectiveness of the system for limiting potentially inappropriate tests was monitored for 6months. RESULTS: Overall, 765/3539 (22%) test requests violated the preset criteria of appropriateness and generated the appearance of electronic alert. After alert appearance, 591 requests were annulled (17% of total tests requested and 77% of tests alerted, respectively). The total number of test requests violating the preset criteria of inappropriateness constantly decreased over time (26% in the first three months of implementation versus 17% in the following period; p<0.001). The total financial saving of test withdrawn was 3387 Euros (12.8% of the total test cost) throughout the study period. CONCLUSIONS: The results of this study suggest that a computerized alert system may be effective to limit the inappropriateness of laboratory test requests, generating significant economic saving and educating physicians to a more efficient use of laboratory resources.
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