Abstract
BackgroundTo reduce overutilization of laboratory testing many interventions have been tried, but selecting the most effective intervention for a given setting is challenging. To be sustainable, interventions need to align with healthcare providers' needs and daily practices. This study aimed to assess the extent of overutilization and the perspectives of healthcare providers, which may be used to guide the choice of intervention.MethodsThe extent of inappropriate laboratory testing in internal medicine inpatients was evaluated using a database. Surveys and focus groups were used to investigate healthcare providers' perceptions on its causes and solutions.ResultsOn average, patients had 5.7 laboratory orders done during the first week of admission, whereas guidelines advise performing laboratory testing no more than twice per week. Repeat testing of normal test results occurred in up to 85% of patients. The frequency of laboratory testing was underestimated by survey responders, even though the majority of responders (78%) thought that laboratory tests are ordered too frequently. Residents were considered to be most responsible for laboratory test ordering.The primary causes of overutilization discussed were personal factors, such as a lack of awareness and knowledge, as well as feelings of insecurity. Regarding possible solutions, residents generally recommended educational interventions, whereas specialists tended to favour technical solutions such as lockouts.ConclusionInappropriate laboratory testing is common in internal medicine. The most important causes are a lack of awareness and knowledge, especially in residents. The intervention most favoured by residents is education, suggesting educational interventions may be most applicable.
Highlights
Laboratory testing affects up to 70% of downstream treatment decisions [1]
In order to effectively implement interventions to increase appropriate laboratory testing, we investigated the current practice of laboratory testing at our department of internal medicine, and what health care professionals think about the causes of the surmised inappropriate test ordering as well as their ideas for potential solutions
We found health care providers to be ambivalent about the problem
Summary
The overutilization of laboratory tests is common and some estimate that one out of every five tests performed is unnecessary [2]. Inappropriate laboratory test utilization increases the potential for diagnostic errors when these tests give false-positive or false-negative results [3,4]. The relevance of the issue of overutilization of laboratory tests is increasingly being recognised, as evidenced by the development of guidelines and campaigns aimed at reducing inappropriate test utilization. This study aimed to assess the extent of overutilization and the perspectives of healthcare providers, which may be used to guide the choice of intervention. Results: On average, patients had 5.7 laboratory orders done during the first week of admission, whereas guidelines advise performing laboratory testing no more than twice per week. Residents were considered to be most responsible for laboratory test ordering
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