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The overuse of laboratory investigations is widely prevalent in hospital practice, including academic departments. 1- 3 Reasons for excessive ordering of tests by doctors include defensive behaviour and fear or uncertainty, lack of experience, the use of protocols and guidelines, "routine" clinical practice, inadequate educational feedback and clinician's unawareness about the cost of examinations. 4- 6 Inappropriate testing causes unnecessary patient discomfort, entails the risk of generating false-positive results, leads to overloading of the diagnostic services, wastes valuable healthcare resources and is associated with other inefficiencies in healthcare delivery, undermining the quality of health services. 1, 5 Interventions on inappropriate testing aim to reduce costs, along with improving the quality of care provided. Results, however, are not always consistent, usually owing to inherent limitations of the strategies proposed. 5, 6
In this study, we assessed the appropriateness of routine ordering of laboratory tests of the trainees in an academic internal medicine department, as well as their awareness about the examination cost; we applied a feedback strategy for reducing the unnecessary ordering of tests, on the basis of the identification of factors associated with inappropriate laboratory utilisation, and reassessed the trainee's test-ordering behaviour after the intervention.
MATERIALS AND METHODS
The medical records of 426 consecutive patients admitted in the wards via the emergency or the outpatient department for a period of 6 months (March-August 2003) were retrospectively reviewed. Patients were excluded from the analysis if (a) they were discharged in <48 h after admission; (b) they were admitted for a reason other than investigation (ie, patients diagnosed with cancer admitted for chemotherapy); (c) their medical records were incomplete or did not contain information adequate for evaluating the rationale for and the usefulness of the ordered tests; and (d) if they had hospitalisation prolonged for social reasons unrelated to their disease course. Table 1 presents the main characteristics of the patients whose records were analysed during the study.
Table 1 Main characteristics of the patients whose medical records were analysed during the study
Before intervention (March-August 2003) | After intervention (November 2003-April 2004) | p Value | |
Patients, n | 426 | 214 | |
Mean age (range) | 67.8 (15-98) | 66.1 (16-104) | NS |
Hospitalisation days (mean, range) | 3845... |