title: A cost-effective method for reducing the volume of laboratory tests in a university-associated teaching hospital.
abstract: BACKGROUND
  Laboratory tests comprise a significant portion of hospital expenditure. Attempts to reduce their use have had mixed results.
  
  
  OBJECTIVE
  To investigate the effect of an intervention based on a simple form-based system for ordering laboratory tests by physicians, on both use of laboratory resources and diagnostic accuracy.
  
  
  METHODS
  At Kaplan Medical Center in Rehovot , Israel , there are 4 similar Internal Medicine departments. In one department (C), the new system was initiated, whereas in the other 3 departments (A, B and D), the traditional method of ordering blood tests was continued. The intervention used was a requirement for tests to be specifically requested by residents following unbundling of test panels, with hands-on supervision by a senior physician. In addition, the residents attended a series of lectures on the economic implications of laboratory testing. The intervention study lasted for 3 years.
  
  
  METHODS
  Total number of tests performed in each department, number of tests per admission and total cost of each test at Medicare reimbursement prices.
  
  
  RESULTS
  The number of tests per admission prior to the intervention was 1.91 +/- 0.89; it decreased for each of the next 3 years: 0.76 +/- 0.61, 0.80 +/- 0.62 and 0.78 +/- 0.63 respectively. There was a total decrease of 97,365 tests during the 3-year period, saving 1,914,149 dollars. There was no difference in the readmission rate or in the number of diagnoses of conditions based primarily on blood tests such as hypokalemia or hyponatremia, between department C and the other departments.
  
  
  CONCLUSIONS
  The intervention developed here produced significant and sustained reduction of financial savings in the number of laboratory tests ordered, without negatively impacting diagnostic capability or patient care.
authors.affiliation: Department of Internal Medicine C, Kaplan Medical Center, Rehovot 76100 Israel.
authors.forename: Malka
authors.initials: M
authors.lastname: Attali
authors.forename: Yosef
authors.initials: Y
authors.lastname: Barel
authors.forename: Marina
authors.initials: M
authors.lastname: Somin
authors.forename: Nick
authors.initials: N
authors.lastname: Beilinson
authors.forename: Mark
authors.initials: M
authors.lastname: Shankman
authors.forename: Ada
authors.initials: A
authors.lastname: Ackerman
authors.forename: Stephen D H
authors.initials: SD
authors.lastname: Malnick
mesh_terms: D003362:Cost-Benefit Analysis; D003955:Diagnostic Tests, Routine / Q000191:economics / Q000706:statistics & numerical data*; D005568:Forms and Records Control; D006403:Hematologic Tests / Q000191:economics / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000191:economics*; D006801:Humans; D007349:Insurance, Health, Reimbursement; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency / Q000592:standards*; D007557:Israel; D007755:Laboratories, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000191:economics; D019564:Unnecessary Procedures; D014600:Utilization Review