title: Using pathology-specific laboratory profiles in clinical pathology to reduce inappropriate test requesting: two completed audit cycles.
abstract: BACKGROUND
  Systematic reviews have shown that, although well prepared, the Consensus Guidelines have failed to change clinical practice. In the healthcare district of Castelnovo né Monti (Reggio Emilia, Italy), it became necessary for the GPs and Clinical Pathologists to work together to jointly define laboratory profiles.
  
  
  METHODS
  Observational study with two cycles of retrospective audit on test request forms, in a primary care setting. Objectives of the study were to develop pathology-specific laboratory profiles and to increase the number of provisional diagnoses on laboratory test request forms. A Multiprofessional Multidisciplinary Inter-hospital Work Team developed pathology-specific laboratory profiles for more effective test requesting. After 8 training sessions that used a combined strategy with multifaceted interventions, the 23 General Practitioners (GPs) in the trial district (Castelnovo nè Monti) tested the profiles; the 21 GPs in the Puianello district were the control group; all GPs in both districts participated in the trial. All laboratory tests for both healthcare districts are performed at the Laboratory located in the trial district. A baseline and a 1-year audit were performed in both districts on the GPs' request forms.
  
  
  RESULTS
  Seven pathology-specific laboratory profiles for outpatients were developed. In the year after the first audit cycle: 1) the number of tests requested in the trial district was distinctly lower than that in the previous year, with a decrease of about 5% (p < 0.001); 2) the provisional diagnosis on the request forms was 52.8% in the trial district and 42% in the control district (P < 0.001); 3) the decrease of the number of tests on each request form was much more marked in the trial district (8.73 vs. 10.77; p < 0.001).
  
  
  CONCLUSIONS
  The first audit cycle showed a significant decrease in the number of tests ordered only in the trial district. The combined strategy used in this study improved the prescriptive compliance of most of the GPs involved. The presence of the clinical pathologist is seen as an added value.
authors: Education and Clinical Innovation Department, Healthcare Library - Clinical Governance Documentation Centre of the Healthcare Trusts of the Province of Reggio Emilia, Arcispedale Santa Maria Nuova Hospital (IRCCS), Reggio Emilia, Italy.
authors: Roberto
authors: R
authors: Baricchi
authors: Michele
authors: M
authors: Zini
authors: Maria Grazia
authors: MG
authors: Nibali
authors: Walter
authors: W
authors: Vezzosi
authors: Vincenzo
authors: V
authors: Insegnante
authors: Clotilde
authors: C
authors: Manfuso
authors: Alessandra
authors: A
authors: Polese
authors: Valmer
authors: V
authors: Costoli
authors: Antonio
authors: A
authors: Spelti
authors: Debora
authors: D
authors: Formisano
authors: Danilo
authors: D
authors: Orlandini
authors: Fausto
authors: F
authors: Nicolini
authors: Antonio
authors: A
authors: Poli
mesh_terms: D019411:Clinical Laboratory Techniques / Q000706:statistics & numerical data*; D003299:Cooperative Behavior; D058006:General Practice / Q000706:statistics & numerical data; D006801:Humans; D033183:Interdisciplinary Communication; D007558:Italy; D008485:Medical Audit; D010338:Pathology, Clinical; D036301:Qualitative Research; D012189:Retrospective Studies; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*