title: Effectiveness of a computerized alert system based on re-testing intervals for limiting the inappropriateness of laboratory test requests.
abstract: OBJECTIVE
  There is consolidated evidence that the burden of inappropriate laboratory test requests is very high, up to 70%. We describe here the function of a computerized alert system linked to the order entry, designed to limit the number of potentially inappropriate laboratory test requests.
  
  
  METHODS
  A computerized alert system based on re-testing intervals and entailing the generation of pop-up alerts when preset criteria of appropriateness for 15 laboratory tests were violated was implemented in two clinical wards of the University Hospital of Parma. The effectiveness of the system for limiting potentially inappropriate tests was monitored for 6months.
  
  
  RESULTS
  Overall, 765/3539 (22%) test requests violated the preset criteria of appropriateness and generated the appearance of electronic alert. After alert appearance, 591 requests were annulled (17% of total tests requested and 77% of tests alerted, respectively). The total number of test requests violating the preset criteria of inappropriateness constantly decreased over time (26% in the first three months of implementation versus 17% in the following period; p<0.001). The total financial saving of test withdrawn was 3387 Euros (12.8% of the total test cost) throughout the study period.
  
  
  CONCLUSIONS
  The results of this study suggest that a computerized alert system may be effective to limit the inappropriateness of laboratory test requests, generating significant economic saving and educating physicians to a more efficient use of laboratory resources.
authors.affiliation: Laboratory of Clinical Chemistry and Hematology, Diagnostic Department, University Hospital of Parma, Parma, Italy. Electronic address: glippi@ao.pr.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lippi
authors.affiliation: Information System, University Hospital of Parma, Parma, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Brambilla
authors.affiliation: Laboratory of Clinical Chemistry and Hematology, Diagnostic Department, University Hospital of Parma, Parma, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Bonelli
authors.affiliation: Laboratory of Clinical Chemistry and Hematology, Diagnostic Department, University Hospital of Parma, Parma, Italy.
authors.forename: Rosalia
authors.initials: R
authors.lastname: Aloe
authors.affiliation: Medical Direction, University Hospital of Parma, Parma, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Balestrino
authors.affiliation: Geriatric Unit, Geriatric-Rehabilitation Department, University Hospital of Parma, Parma, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Nardelli
authors.affiliation: Department of Clinical and Experimental Medicine, Section of Geriatrics, University of Parma, Parma, Italy.
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Ceda
authors.affiliation: General Direction, University Hospital of Parma, Parma, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Fabi
mesh_terms: D020000:Decision Support Systems, Clinical; D006785:Hospitals, University; D006801:Humans; D013677:Medical Laboratory Science / Q000379:methods*; D050316:Medical Order Entry Systems
keywords: Alert; Inappropriateness; Laboratory diagnostics; Patient safety