title: Failed Attempts to Reduce Inappropriate Laboratory Utilization in an Emergency Department Setting in Cyprus: Lessons Learned.
abstract: BACKGROUND
  Laboratory test ordering is a significant part of the diagnosis definition and disease treatment monitoring process. Inappropriate laboratory test ordering wastes scarce resources, places unnecessary burden on the health care delivery system, and exposes patients to unnecessary discomfort. Inappropriate ordering is caused by many factors, such as lack of guidelines, defensive medicine, thoughtless ordering, and lack of awareness of costs incurred to the system.
  
  
  OBJECTIVE
  The purpose of this study is to assess two successive measures, which were introduced in a Cyprus emergency department (ED) for the purpose of synergistically reducing inappropriate laboratory ordering: the introduction of a copayment fee to reduce nonemergent visits, and the development of a Web-based protocol defining the tests emergency physicians could order.
  
  
  METHODS
  An autoregressive integrated moving average model for interrupted time series analysis was constructed. Data include number and type of tests ordered, along with number of visits for a period of 4 years from an ED in Cyprus.
  
  
  RESULTS
  Copayment fee and introduction of a revised Web-based protocol for a test ordering form did not reduce the number of ordered tests in the ED unit. Copayment fee alone resulted in a statistically significant reduction in ED visits.
  
  
  CONCLUSIONS
  The implementation of two consecutive measures resulted in an increase of ordered tests per patient. Laboratory ordering is a multidimensional process that is primarily supplier induced, therefore, all underlying possible causes must be scrutinized by health authorities. These include lack of guidelines, defensive medicine and thoughtless prescribing. To attain significant gains, an integrated approach must be implemented.
authors.affiliation: Health Insurance Organization, Nicosia, Cyprus.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Petrou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D019411:Clinical Laboratory Techniques / Q000191:economics / Q000706:statistics & numerical data*; D002985:Clinical Protocols / Q000592:standards*; D017047:Cost Sharing; D003535:Cyprus; D003955:Diagnostic Tests, Routine / Q000191:economics / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006300:Health Services Misuse / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D065186:Interrupted Time Series Analysis; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Cyprus; Web-based test panel algorithm; co-payment; emergency department; inappropriate laboratory ordering