Katri Seppänen1, Timo Kauppila2, Kaisu Pitkälä3, Hannu Kautiainen4, Raija Puustinen5, Antti Iivanainen6, Tiina Mäki7. 1. Department of Primary Health Care Laboratory Services, Helsinki University Central Hospital, Laboratory Services (HUSLAB), Paciuksenkatu 29, P.O. Box 720, 00027 HUS Helsinki, Finland. Electronic address: katri.seppanen@hus.fi. 2. Department of General Practice and Primary Healthcare, University of Helsinki, and Unit of Primary Health Care, Helsinki University Central Hospital, (HUS), Tukholmankatu 8 B, P.O. Box 20, 00014 Helsinki, Finland. Electronic address: timo.kauppila@fimnet.fi. 3. Department of General Practice and Primary Healthcare, University of Helsinki, and Unit of Primary Health Care, Helsinki University Central Hospital, (HUS), Tukholmankatu 8 B, P.O. Box 20, 00014 Helsinki, Finland. Electronic address: kaisu.pitkala@helsinki.fi. 4. Department of General Practice and Primary Healthcare, University of Helsinki, and Unit of Primary Health Care, Helsinki University Central Hospital, (HUS), Tukholmankatu 8 B, P.O. Box 20, 00014 Helsinki, Finland. Electronic address: hannu.kautiainen@medcare.fi. 5. Health Center of City of Helsinki, Siltasaarenkatu 13, P.O. Box 1, 00099 City of Helsinki, Finland. Electronic address: raija.puustinen@helsinki.fi. 6. Health Center of City of Helsinki, Siltasaarenkatu 13, P.O. Box 1, 00099 City of Helsinki, Finland. Electronic address: antti.iivanainen@helsinki.fi. 7. Department of Primary Health Care Laboratory Services, Helsinki University Central Hospital, Laboratory Services (HUSLAB), Paciuksenkatu 29, P.O. Box 720, 00027 HUS Helsinki, Finland. Electronic address: tiina.maki@hus.fi.
Abstract
BACKGROUND: To reduce physicians' inappropriate laboratory requests for their patients, administrators have used methods such as modifying a laboratory request order form with an agreed requesting protocol for the most common diagnoses in primary health care. OBJECTIVE: To study the effects of removing the erythrocyte sedimentation rate (ESR) and aspartate transaminase (AST) which are considered of limited clinical value for primary care clinical decision-making from a computerized laboratory test order form. These tests were removed to another new view from the electronic laboratory menu where the physicians, instead of just ticking the desired test from the list, had to do 4-8s extra work by writing down the abbreviation to order the test. METHODS: An observational controlled prospective study based on a before-after design was performed by removing AST and ES from the laboratory test order form of the computerized laboratory system for all primary care in the city of Helsinki, Finland. The numbers of annual and monthly use of AST and ESR and their controls, alanine transaminase (ALT) and C-reactive protein (CRP) ordered by General practitioners (GPs) was recorded over an eight-year period: four years before and a four years after the removal of AST and ES. RESULTS: Removing AST and ESR from the computerized laboratory test order form decreased their use by up to 90%, whereas the use of the control tests increased throughout the follow-up period. The variation in use of these removed tests also decreased. CONCLUSION: Removing a laboratory test from a computerized laboratory test order form may significantly reduce GPs' use of the laboratory test. Further studies are needed, however, to ensure the safety of this type of intervention.
BACKGROUND: To reduce physicians' inappropriate laboratory requests for their patients, administrators have used methods such as modifying a laboratory request order form with an agreed requesting protocol for the most common diagnoses in primary health care. OBJECTIVE: To study the effects of removing the erythrocyte sedimentation rate (ESR) and aspartate transaminase (AST) which are considered of limited clinical value for primary care clinical decision-making from a computerized laboratory test order form. These tests were removed to another new view from the electronic laboratory menu where the physicians, instead of just ticking the desired test from the list, had to do 4-8s extra work by writing down the abbreviation to order the test. METHODS: An observational controlled prospective study based on a before-after design was performed by removing AST and ES from the laboratory test order form of the computerized laboratory system for all primary care in the city of Helsinki, Finland. The numbers of annual and monthly use of AST and ESR and their controls, alanine transaminase (ALT) and C-reactive protein (CRP) ordered by General practitioners (GPs) was recorded over an eight-year period: four years before and a four years after the removal of AST and ES. RESULTS: Removing AST and ESR from the computerized laboratory test order form decreased their use by up to 90%, whereas the use of the control tests increased throughout the follow-up period. The variation in use of these removed tests also decreased. CONCLUSION: Removing a laboratory test from a computerized laboratory test order form may significantly reduce GPs' use of the laboratory test. Further studies are needed, however, to ensure the safety of this type of intervention.
Authors: Victoria O'Driscoll; Ilinca Georgescu; Irene Koo; Rebecca Arthur; Rita Chuang; Jillian Ann Dempsey; Giulia De Franco; Claire Ann Jones Journal: Fertil Res Pract Date: 2021-04-30