A cost-effective method for reducing the volume of laboratory tests in a university-associated teaching hospital.
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.
Attali
Malka
M
Department of Internal Medicine C, Kaplan Medical Center, Rehovot 76100 Israel.
Barel
Yosef
Y
Somin
Marina
M
Beilinson
Nick
N
Shankman
Mark
M
Ackerman
Ada
A
Malnick
Stephen D H
SD
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