title: How to save costs by reducing unnecessary testing: lean thinking in clinical practice.
abstract: BACKGROUND
  The burden of health care expenditure on national budgets has increased dramatically over the past decade. A pilot study in our hospital demonstrated that many unnecessary diagnostic tests were performed routinely. The aim of this study was to reduce the costs of unnecessary diagnostic tests.
  
  
  METHODS
  All diagnostic costs between 2006 and 2008 of the internal medicine department of the VU University Centre were evaluated. A target was set to reduce diagnostic expenditure by 7.5% in 2009 compared to 2008. A few interventions were introduced including introducing posters and pocket cards detailing the costs of diagnostic tests, six weekly feedback on diagnostics costs, mentorship of junior doctors, unbundling panel tests and increasing protocol adherence. Main outcome measures were the reduction in the total diagnostic costs and the total number of laboratory tests performed in the internal medicine department in 2009.
  
  
  RESULTS
  In 2009, we achieved a 13% reduction in the total diagnostic costs compared to 2008. The department of internal medicine spent 2.80 million euro and 2.45 million euro on the diagnostic tests in 2008 and 2009 respectively and thereby saved 350.000 euro in 2009. The largest reduction was achieved by reducing the number of laboratory tests performed.
  
  
  CONCLUSIONS
  Introduction of a few simple measures to improve awareness among the physicians led to a significant reduction in the diagnostic costs in the department of internal medicine. Extending these measures to the entire hospital and even entire country will in our opinion lead to significant reduction in the health care costs.
authors.affiliation: Department of Internal Medicine, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Irene L
authors.initials: IL
authors.lastname: Vegting
authors.forename: Marlou
authors.initials: M
authors.lastname: van Beneden
authors.forename: Mark H H
authors.initials: MH
authors.lastname: Kramer
authors.forename: Abel
authors.initials: A
authors.lastname: Thijs
authors.forename: Piet J
authors.initials: PJ
authors.lastname: Kostense
authors.forename: Prabath W B
authors.initials: PW
authors.lastname: Nanayakkara
mesh_terms: D017046:Cost Savings; D003955:Diagnostic Tests, Routine / Q000191:economics*; D006801:Humans; D010865:Pilot Projects; D019564:Unnecessary Procedures / Q000191:economics* / Q000706:statistics & numerical data*