title: Sustained reductions in emergency department laboratory test orders: impact of a simple intervention.
abstract: OBJECTIVE
  To determine whether a pathology request form allowing interns and residents to order only a limited range of laboratory blood tests prior to consultation with a registrar or consultant can reduce test ordering in an emergency department (ED).
  
  
  METHODS
  A prospective before-and-after study in an adult tertiary-referral teaching hospital ED was conducted. A pathology request form with a limited list of permissible tests was implemented for use by junior medical officers. Tests for patients 16 years and older presenting in a 20-week pre-intervention period from 19 January 2009 were compared with those in a corresponding 20-week post-intervention period from 18 January 2010. Main outcome measures were the number and cost of blood tests ordered.
  
  
  RESULTS
  24 652 and 25 576 presentations were analysed in the pre- and post-intervention periods, respectively. The mean number of blood tests ordered per 100 ED presentations fell by 19% from 172 in the pre- to 140 in the post-intervention period (p=0.001). The mean cost of blood tests ordered per 100 ED presentations fell by 17% from $A3177 in the pre- to $A2633 in the post-intervention period (p=0.001). There were falls in the number of coagulation profiles (11.1 vs 4.8/100 patients), C-reactive protein (5.6 vs 2.7/100 patients), erythrocyte sedimentation rate (2.5 vs 1.3/100 patients) and thyroid function tests (2.2 vs 1.6/100 patients).
  
  
  CONCLUSIONS
  Pathology request forms limiting tests that an intern and resident may order prior to consultation with a registrar or consultant are an effective low maintenance method for reducing laboratory test ordering in the ED that is sustainable over 12 months.
authors.affiliation: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, , Brisbane, Queensland, Australia.
authors.forename: Kevin H
authors.initials: KH
authors.lastname: Chu
authors.forename: Amol S
authors.initials: AS
authors.lastname: Wagholikar
authors.forename: Jaimi H
authors.initials: JH
authors.lastname: Greenslade
authors.forename: John A
authors.initials: JA
authors.lastname: O'Dwyer
authors.forename: Anthony F
authors.initials: AF
authors.lastname: Brown
mesh_terms: D000328:Adult; D001315:Australia; D019411:Clinical Laboratory Techniques / Q000191:economics / Q000706:statistics & numerical data*; D003955:Diagnostic Tests, Routine / Q000191:economics* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000191:economics*; D005260:Female; D017722:Hospital Charges / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data; D011446:Prospective Studies; D012017:Referral and Consultation; D019564:Unnecessary Procedures / Q000706:statistics & numerical data; D055815:Young Adult
keywords: ACCIDENT & EMERGENCY MEDICINE; HEALTH SERVICES ADMINISTRATION & MANAGEMENT; PATHOLOGY