title: Cost and turn-around time display decreases inpatient ordering of reference laboratory tests: a time series.
abstract: OBJECTIVE
  Reference tests, also known as send-out tests, are commonly ordered laboratory tests with variable costs and turn-around times. We aim to examine the effects of displaying reference laboratory costs and turn-around times during computerised physician order entry (CPOE) on inpatient physician ordering behaviour.
  
  
  METHODS
  We conducted a prospective observational study at a tertiary care hospital involving inpatient attending physicians and residents. Physician ordering behaviour was prospectively observed between September 2010 and December 2012. An intervention was implemented to display cost and turn-around time for reference tests within our CPOE. We examined changes in the mean number of monthly physician orders per inpatient day at risk, the mean cost per order, and the average turn-around time per order.
  
  
  RESULTS
  After our intervention, the mean number of monthly physician orders per inpatient day at risk decreased by 26% (51 vs 38, p<0.0001) with a decrease in mean cost per order (US$146.50 vs US$134.20, p=0.0004). There were no significant differences in mean turn-around time per order (5.6 vs 5.7 days, p=0.057). A stratified analysis of both cost and turn-around time showed significant decreases in physician ordering. The intervention projected a mean annual savings of US$330 439. Reference test cost and turn-around time variables were poorly correlated (r=0.2). These findings occurred in the setting of non-significant change to physician ordering in a control cohort of non-reference laboratory tests.
  
  
  CONCLUSIONS
  Display of reference laboratory cost and turn-around time data during real-time ordering may result in significant decreases in ordering of reference laboratory tests with subsequent cost savings.
authors.affiliation: Department of Medicine, Stanford University Medical Center, Stanford, California, USA.
authors.forename: Daniel Z
authors.initials: DZ
authors.lastname: Fang
authors.affiliation: Department of Medicine, Stanford University Medical Center, Stanford, California, USA.
authors.forename: Gurmeet
authors.initials: G
authors.lastname: Sran
authors.affiliation: Department of Medicine, Stanford University Medical Center, Stanford, California, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Gessner
authors.affiliation: Department of Medicine, Stanford University Medical Center, Stanford, California, USA.
authors.forename: Pooja D
authors.initials: PD
authors.lastname: Loftus
authors.affiliation: Department of Pathology, Stanford University Medical Center, Stanford, California, USA.
authors.forename: Ann
authors.initials: A
authors.lastname: Folkins
authors.affiliation: Department of Medicine, Stanford University Medical Center, Stanford, California, USA.
authors.forename: John Y
authors.initials: JY
authors.lastname: Christopher
authors.affiliation: Department of Medicine, Stanford University Medical Center, Stanford, California, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Shieh
mesh_terms: D002140:California; D017046:Cost Savings; D003955:Diagnostic Tests, Routine / Q000191:economics*; D006785:Hospitals, University; D006801:Humans; D007297:Inpatients; D050316:Medical Order Entry Systems; D010818:Practice Patterns, Physicians' / Q000191:economics*; D011446:Prospective Studies; D013996:Time and Motion Studies
keywords: Cost-effectiveness; Decision support, computerized; Hospital medicine; Laboratory medicine; Quality improvement