Appropriate use of laboratory test requests in the emergency department: a multilevel intervention.

OBJECTIVE: Laboratory test requests in the emergency department (ED) are increasing worldwide. We evaluated whether a multilevel intervention on the basis of the optimization of test profiles and educational meetings with physicians could reduce the number of tests ordered. PATIENTS AND METHODS: In a single-center before and after study design, the 8-month intervention period was compared with the 8-month preintervention period. Laboratory test profiles were reduced from 6 to 2 and the number of tests in each profile was reduced by 50%. All physicians received education about the costs and appropriate use of the tests. Primary outcomes were the number of laboratory blood tests and their costs, with a focus on high-cost tests. Secondary outcomes were ED and laboratory performances (patients' waiting time, number of deaths in ED, re-entry, laboratory turn-around time, and add-on tests). RESULTS: Overall, 61 976 and 61 154 patients were evaluated, respectively, during the intervention and the preintervention period. Laboratory blood test requests were decreased by 207 637 (-36.3%) in the intervention period (P < 0.05), which corresponds to a reduction of 337.3 tests/100 patients. Costs were decreased by 608 079&OV0556; ( - 29.6%, P < 0.05), leading to a cost reduction of 981.2&OV0556;/100 patients. High-cost test requests decreased by 11 457 ( - 27.3%) and contributed toward the overall reduction in costs with 197 206&OV0556; ( - 30.5%). No significant differences were found in ED and laboratory performances between intervention and preintervention periods. CONCLUSIONS: Optimization of test profiles and education on the costs and appropriate use of the tests significantly reduced laboratory test ordering and costs without affecting ED and laboratory performances.

[Design and arrangement of the CHIP (CHinese In Prato) study]. / Disegno e modalità di realizzazione dello studio CHIP (CHinese In Prato).

Following the rapid economic development, China is experiencing a progressive increase in the incidence of cardiovascular (CV) events and in the prevalence of CV risk factors. According to recent estimations, the prevalence of diabetes sharply increased from 1% in 1980 to 11% in 2013. Migration from China to Europe is now mainly concentrated in Countries of the Southern Europe, e.g., Italy and Spain. The largest Chinese community living in Italy is now settled in Prato, being also one of the largest Chinese community in Europe. Local authorities estimate a number of Chinese citizens living in Prato of over 40,000 individuals, including illegal immigrants. The availability of reliable data on the health needs of Chinese population is thus a recognised priority for the local health system. The creation of a participatory research where Chinese population directly participates in the formation of a group of citizens involved in designing and conducting the survey allows to overcome difficulties due to the lack of official demographic files. Secondly, and most important, this approach makes it possible to effectively pass a prevention message to an elusive population. The purpose of the CHIP (CHinese In Prato) survey is to investigate the prevalence of diabetes and cardiovascular risk factors among Chinese immigrants. Recruitment procedure was started on 8th July 2014.