Abstract
Background: Unnecessary laboratory tests contribute to the financial burden placed on hospitals, patients, insurers, and taxpayers. In our institution, we noted acute viral hepatitis serologic testing in patients with chronic liver disease, sometimes done repetitively, in the absence of substantially elevated aminotransferase levels. The goal of this study was to determine the frequency of unnecessary testing for acute hepatitis A and B infections and then reduce testing rates by implementing an intervention in the electronic health record.Methods: In a 2-year period, 2 successive interventions questioning the appropriateness of ordering viral hepatitis serology based on transaminase elevation and prior serology results were implemented in the electronic health record system at Saint Louis University Hospital. The first intervention allowed providers to override the warning without providing a reason; the second intervention required justification to proceed with the order. Preintervention and postintervention appropriate and inappropriate testing proportions were compared using Fisher exact test.Results: The electronic reminders resulted in a statistically significant reduction of inappropriate testing rates; however, testing rates remained high whether the provider had to justify overriding the automatic alert or not.Conclusion: Our research demonstrated that the rates of inappropriate testing for acute viral hepatitis at our institution were unnecessarily high and showed that a simple intervention in the medical record system may be useful in reducing inappropriate testing. Our interventions were feasible and implemented at minimal cost. Similar interventions could be used to target other unnecessary tests, but education and additional interventions will likely be required to reduce unnecessary testing further.
Highlights
As a percentage of gross domestic product (GDP), more money is spent on healthcare in the United States than in any other developed country.[1]
The Centers for Disease Control and Prevention reported that between the years 1975 and 2015, national health expenditures in the United States as a percent of GDP increased from 7.9% to 17.8%
The goal of the present research was to determine the rates of unnecessary acute viral hepatitis testing at a tertiary care university hospital and assess the impact of an electronic health record (EHR) educational guidance statement
Summary
As a percentage of gross domestic product (GDP), more money is spent on healthcare in the United States than in any other developed country.[1]. By 2015, spending had increased to $2.7 trillion, an average of $8,468 per person per year.[2] A significant proportion of these costs has been attributed to unnecessary services or expenditures that providers can directly avoid by optimizing their practice.[3] Laboratory tests, which play a vital role in the medical decision-making process, can contribute to excess healthcare expenditures when inappropriately used. The goal of this study was to determine the frequency of unnecessary testing for acute hepatitis A and B infections and reduce testing rates by implementing an intervention in the electronic health record. Methods: In a 2-year period, 2 successive interventions questioning the appropriateness of ordering viral hepatitis serology based on transaminase elevation and prior serology results were implemented in the electronic health record system at Saint Louis University Hospital. Similar interventions could be used to target other unnecessary tests, but education and additional interventions will likely be required to reduce unnecessary testing further
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call