title: Practical motives are prominent in test-ordering in the Emergency Department.
abstract: BACKGROUND
  Laboratory test ordering under time pressure may impact test-ordering behavior.
  
  
  METHODS
  To investigate the test-ordering behavior of doctors working under such pressure, we designed a questionnaire for trainees and staff in the Emergency Department (ED). This questionnaire addressed topics such as necessity of requested tests, time spent on ordering, costs and availability of tests, and the time of the day. We hypothesized that ordering behavior would be guided predominantly by the medical need of tests and aimed at identifying practical motives that also have an effect.
  
  
  RESULTS
  Remarkably, two-third of the respondents (67%) admitted that tests were ordered that would not influence treatment policy directly and 48% of the doctors stated that tests were ordered that do not impact treatment at all. The frequency of such orders was "sometimes" and "frequent" in a 50:50 ratio. Interestingly, tests that could prove relevant at a later stage are often ordered simultaneously to reduce burden on the patient. None of the respondents spent more than 3 min on the ordering process and very few (8%) desired more time for ordering. Most respondents (81%) declared to have limited knowledge of the costs of laboratory tests. A random survey covering four tests confirmed this. Generally, turnaround time did influence ordering behavior while time of the day did not.
  
  
  CONCLUSIONS
  In conclusion, doctors in an ED - besides first of all medical motives - heavily exploit practical (non-medical) reasoning for laboratory test ordering, e.g. taking availability of tests into account and ordering non-immediate tests.
authors.affiliation: .
authors.forename: Armando
authors.initials: A
authors.lastname: van der Horst
authors.affiliation: .
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: van de Wijngaart
authors.affiliation: .
authors.forename: Jolanda
authors.initials: J
authors.lastname: Scherrenburg
authors.affiliation: .
authors.forename: Nadine
authors.initials: N
authors.lastname: van Dijk
authors.affiliation: .
authors.forename: Pim M W
authors.initials: PMW
authors.lastname: Janssens
mesh_terms: D003404:Creatinine / Q000097:blood; D003955:Diagnostic Tests, Routine / Q000191:economics / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D013997:Time Factors
chemical_list: D006454:Hemoglobins; D003404:Creatinine
keywords: emergency medicine; medical motives; non-medical motives; test-ordering behavior