ABSTRACT
OBJECTIVES: Inappropriate use of laboratory testing remains a challenging problem worldwide. Minimum retest intervals (MRI) are used to reduce inappropriate laboratory testing. However, their effectiveness and the usefulness in reducing inappropriate laboratory testing is still a matter of debate. The aim of this study was to evaluate the effectiveness of broadly implemented MRIs as a means of reducing inappropriate laboratory test requests. METHODS: We performed a retrospective study in a general care and teaching hospital in the Netherlands, where MRI alerts have been implemented as standard care since June 7th 2017. Clinical chemistry test orders in adult internal medicine patients placed between July 13th 2017 and December 31st 2019 were included. The primary outcome was the effectiveness of MRIs, expressed as percentages of tests ordered and barred as a result of MRIs. RESULTS: Of a total of 218,511 test requests, 4,159 (1.90%) got an MRI alert. These MRIs were overruled by physicians in 21.76% of the cases. As a result of implementing MRIs, 3,254 (1.49%) tests were barred. The financial savings for the department of internal medicine directly related to the included barred laboratory tests during this period were 11,880 euros on a total amount of 636,598 euros for all performed tests. CONCLUSIONS: Only a small proportion of laboratory tests are barred after implementation of MRIs, with a limited impact on the annual costs. However, MRIs provide a continuous reminder to focus on appropriate testing and the effectiveness of MRIs is potentially higher than described in this study.
Subject(s)
Hospitals , Magnetic Resonance Imaging , Adult , Humans , Retrospective Studies , Costs and Cost Analysis , NetherlandsABSTRACT
Importance: Inappropriate use of laboratory testing is a challenging problem. Estimated overuse rates of approximately 20% have been reported. Effective, sustainable solutions to stimulate optimal use are needed. Objective: To determine the association of a multifaceted intervention with laboratory test volume. Design, Setting, and Participants: A before-after quality improvement study was performed between August 1, 2016, and April 30, 2018, in the internal medicine departments of 4 teaching hospitals in the Netherlands. Data on laboratory order volumes from 19 comparable hospitals were used as controls. The participants were clinicians ordering laboratory tests. Interventions: The intervention included creating awareness through education and feedback, intensified supervision of residents, and changes in order entry systems. Interventions were performed by local project teams and guided by a central project team during a 6-month period. Sustainability was investigated during an 8-month follow-up period. Main Outcomes and Measures: The primary outcome was the change in slope for laboratory test volume. Secondary outcomes were change in slope for laboratory expenditure, order volumes and expenditure for other diagnostic procedures, and clinical outcomes. Data were collected on duration of hospital stay, rate of repeated outpatient visits, 30-day readmission rate, and rate of unexpected prolonged duration of hospital stay for patients admitted for pneumonia. Results: The numbers of internists and residents ordering tests in hospitals 1 to 4 were 16 and 30, 18 and 20, 13 and 17, and 21 and 60, respectively. Statistically significant changes in slope for laboratory test volume per patient contact were found at hospital 1 (change in slope, -1.55; 95% CI, -1.98 to -1.11; P < .001), hospital 3 (change in slope, -0.74; 95% CI, -1.42 to -0.07; P = .03), and hospital 4 (change in slope, -2.18; 95% CI, -3.27 to -1.08; P < .001). At hospital 2, the change in slope was not statistically significant (-0.34; 95% CI, -2.27 to 1.58; P = .73). Laboratory test volume per patient contact decreased by 11.4%, whereas the volume increased by 2.4% in 19 comparable hospitals. Statistically significant changes in slopes for laboratory costs and volumes and costs for other diagnostic procedures were also observed. Clinical outcomes were not associated with negative changes. Important facilitators were education, continuous attention for overuse, feedback, and residents' involvement. Important barriers were difficulties in data retrieval, difficulty in incorporation of principles in daily practice, and high resident turnover. Conclusions and relevance: A set of interventions aimed at changing caregivers' mindset was associated with a reduction in the laboratory test volume in all departments, whereas the volume increased in comparable hospitals in the Netherlands. This study provides a framework for nationwide implementation of interventions to reduce unnecessary laboratory testing.
