title: Reducing unnecessary testing: an intervention to improve resident ordering practices.
abstract: OBJECTIVE
  To reduce the number of unnecessary laboratory tests ordered through a measurement of effects of education and cost awareness on laboratory ordering behaviour by internal medicine residents for common tests, including complete blood cell count (CBC) and renal profile (RP), and to evaluate effects of cost awareness on hospitalisation, 30-day readmission rate and mortality rate.
  
  
  METHODS
  567 patients admitted during February, March and April 2014 were reviewed as the control group. Total CBC, CBC with differential and RP tests were counted, along with readmission and mortality rates. Interventions were education and visual cost reminders. The same tests were reassessed for 629 patients treated during 12 months after intervention in 2015.
  
  
  RESULTS
  Data showed a significant increase in CBCs ordered after the intervention (mean number per hospitalisation changed from 1.7 to 2.3 (p<0.001)), a decrease in CBCs with differential (mean number changed from 1.7 to 1.2 (p<0.001)) and no change in RPs ordered (mean number, 3.7 both before and after intervention (p=0.23)). No change was found in mortality rate, but the decrease in the readmission rate was significant (p=0.008).
  
  
  CONCLUSIONS
  Education in the form of cost reminders did not significantly reduce the overall ordering of the most common daily laboratory testing in our academic teaching service. We believe further research is needed to fully evaluate the effectiveness of other education forms on the redundant ordering of tests in the hospital setting.
authors.affiliation: Division of Gastroenterology, Cleveland Clinic Florida, Florida, USA.
authors.forename: Jose
authors.initials: J
authors.lastname: Melendez-Rosado
authors.affiliation: Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Kristine M
authors.initials: KM
authors.lastname: Thompson
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Jed C
authors.initials: JC
authors.lastname: Cowdell
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Catalina
authors.initials: C
authors.lastname: Sanchez Alvarez
authors.affiliation: Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Ryan L
authors.initials: RL
authors.lastname: Ung
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Armando
authors.initials: A
authors.lastname: Villanueva
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Kayin B
authors.initials: KB
authors.lastname: Jeffers
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Jaafer S
authors.initials: JS
authors.lastname: Imam
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Mario V
authors.initials: MV
authors.lastname: Mitkov
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Tasneem A
authors.initials: TA
authors.lastname: Kaleem
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Lewis
authors.initials: L
authors.lastname: Jacob
authors.affiliation: Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Dawson
mesh_terms: D000368:Aged; D057189:Checklist; D003363:Cost Control; D003955:Diagnostic Tests, Routine / Q000191:economics*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000191:economics; D010818:Practice Patterns, Physicians' / Q000191:economics*; D019564:Unnecessary Procedures / Q000191:economics*
keywords: cost awareness; daily laboratory testing; resident education