A survey of doctors reveals that few laboratory tests are of primary importance at the Emergency Department.

ABSTRACT

BACKGROUND: Laboratory tests in hospitals are among the most important diagnostic tools for medical decision making at the Emergency Department. They are often ordered as part of extended test panels, which, although helpful and convenient for doctors, may lead to overuse of tests and overdiagnosis. To improve the ordering process, we investigated which laboratory tests are essential for optimal decision making at the Emergency Department of our hospital. METHODS: Forty-nine doctors regularly involved with the Emergency Department filled in a questionnaire asking for their opinions on laboratory test ordering and use. RESULTS: A limited number of laboratory tests are considered indispensable for the Emergency Department CRP and leukocytes, urea and creatinin, sodium and potassium, and haemoglobin. Glucose and troponin should probably also be included in this list, but were not mentioned as glucose is measured using portable point-of-care devices in our hospital, while cardiac patients are referred directly to the cardiac care unit. CONCLUSIONS: Only a limited number of laboratory tests are essential for early medical decision making at the Emergency Department. Ordering facilities should be arranged such that these tests are permanently available, easy to order, and performed with short turnaround times. Test panels for the ED should incorporate these essential tests, with additional other tests so as to prevent essential tests from being forgotten, maintain convenience for doctors and promote sensible and effective use of diagnostic testing. The outcome of these conflicting aims is a compromise, as is discussed.