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Sustained reductions in emergency department laboratory test orders: impact of a simple intervention
  1. Kevin H Chu1,2,
  2. Amol S Wagholikar3,
  3. Jaimi H Greenslade1,2,
  4. John A O'Dwyer3,
  5. Anthony F Brown1,2
  1. 1Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
  2. 2Burns, Trauma and Critical Care Research Centre, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
  3. 3Australian e-Health Research Centre, CSIRO ICT Centre, Brisbane, Queensland, Australia
  1. Correspondence to Dr Kevin Chu, Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD 4029, Australia; k.chu{at}uq.edu.au

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.

  • Accident & Emergency Medicine
  • Pathology
  • Health Services Administration & Management

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