Sustained reductions in emergency department laboratory test orders: impact of a simple intervention

Chu, K.H., Wagholikar, A.S., Greenslade, J.H., O'Dwyer, J.A. and Brown, A.F. (2013) Sustained reductions in emergency department laboratory test orders: impact of a simple intervention. Postgraduate Medical Journal, 89 1056: 566-571. doi:10.1136/postgradmedj-2012-130833


Author Chu, K.H.
Wagholikar, A.S.
Greenslade, J.H.
O'Dwyer, J.A.
Brown, A.F.
Title Sustained reductions in emergency department laboratory test orders: impact of a simple intervention
Journal name Postgraduate Medical Journal   Check publisher's open access policy
ISSN 0032-5473
1469-0756
Publication date 2013-10
Sub-type Article (original research)
DOI 10.1136/postgradmedj-2012-130833
Open Access Status
Volume 89
Issue 1056
Start page 566
End page 571
Total pages 6
Place of publication London, England, U.K.
Publisher B M J Group
Collection year 2014
Language eng
Formatted abstract
Objectives To determine whether a pathology request form allowing interns and residents to order only a limited range of laboratory blood tests prior to consultation with a registrar or consultant can reduce test ordering in an emergency department (ED).

Methods A prospective before-and-after study in an adult tertiary-referral teaching hospital ED was conducted. A pathology request form with a limited list of permissible tests was implemented for use by junior medical officers. Tests for patients 16 years and older presenting in a 20-week pre-intervention period from 19 January 2009 were compared with those in a corresponding 20-week post-intervention period from 18 January 2010. Main outcome measures were the number and cost of blood tests ordered.

Results 24 652 and 25 576 presentations were analysed in the pre- and post-intervention periods, respectively. The mean number of blood tests ordered per 100 ED presentations fell by 19% from 172 in the pre- to 140 in the post-intervention period (p=0.001). The mean cost of blood tests ordered per 100 ED presentations fell by 17% from $A3177 in the pre- to $A2633 in the post-intervention period (p=0.001). There were falls in the number of coagulation profiles (11.1 vs 4.8/100 patients), C-reactive protein (5.6 vs 2.7/100 patients), erythrocyte sedimentation rate (2.5 vs 1.3/100 patients) and thyroid function tests (2.2 vs 1.6/100 patients).

Conclusions Pathology request forms limiting tests that an intern and resident may order prior to consultation with a registrar or consultant are an effective low maintenance method for reducing laboratory test ordering in the ED that is sustainable over 12 months.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Medicine Publications
 
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Created: Fri, 14 Mar 2014, 07:55:36 EST by Matthew Lamb on behalf of School of Medicine