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Int J Qual Health Care. 2005 Jun;17(3):243-8. Epub 2005 Apr 18.

An administrative intervention to improve the utilization of laboratory tests within a university hospital.

Author information

  • 1Hadassah University Hospital, Hebrew University School of Medicine, Jerusalem, Israel. ronitca@hadassah.org.il

Abstract

BACKGROUND:

Improving the appropriateness of testing behavior and reducing the number of laboratory tests have been recognized as essential parts of quality improvement.

OBJECTIVE:

To assess the effectiveness of an administrative and a short-term educational intervention aimed at reducing clinical biochemistry laboratory utilization.

DESIGN:

An analysis comparing utilization of laboratory tests performed on in-patients before and after the intervention.

SETTING:

Computerized database of all laboratory tests performed in Hadassah Ein Kerem Medical Center, Jerusalem, Israel during 1999-2003.

INTERVENTION:

The administrative intervention included restricting available emergency laboratory tests and frequency of repeated orders. The educational measures included: discussion of the misuse of laboratory tests and its consequences with the hospital medical staff, and presentation of the new restrictive policy. A feedback of the intervention's results was sent to the wards and reviewed with senior medical staff.

MAIN OUTCOME MEASURES:

Change in utilization (measured as rates per 100 hospital days) of clinical biochemistry tests by hospital division and by selected laboratory tests.

RESULTS:

An overall reduction of 19% in laboratory tests (95% CI: 18.8-19.2%) was observed in the year after the intervention. Utilization decreased significantly in all the hospital's medical divisions, within a range of 14.9-43.8%. During the intervention period, utilization of hematology tests was reduced by 7.6% (P = 0.009). Statistically significant reductions were noted in the ordering of all 12 selected clinical biochemistry tests. Although the orders of total cholesterol decreased by 72.2%, the utilization of 'high-volume' tests, such as glucose and electrolytes, showed only a modest decrease (7.9% and 6.9%, respectively).

CONCLUSIONS:

The present study included all hospital medical staff and covered all the available clinical biochemistry tests. This rather simple and low-cost intervention resulted in significant reductions in clinical biochemistry test orders as well as in the ordering of hematological blood tests.

PMID:
15837715
[PubMed - indexed for MEDLINE]
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