title: Evaluating the appropriateness of hospital doctors' requests for pulmonary function tests beyond basic spirometry: results from a prospective observational study.
abstract: OBJECTIVE
  Hospitalists request 'complete' pulmonary function tests (PFTs), typically comprising of spirometry, diffusion capacity of the lung for carbon monoxide (DLCO) and absolute lung volumes (ALVs), the results of which assist in the management of patients with respiratory disorders. Recently, concerns have been raised about over-requesting of 'complete' PFTs, but there is a paucity of information on the proportion of requests that can be considered clinically inappropriate. This study prospectively evaluated the 'complete' PFTs requested in a hospital service and assessed the impact of medical review of the requests.
  
  
  METHODS
  A six-month prospective study on requests to two teaching hospital PFT laboratories from non-respiratory doctors was undertaken. Requests at one laboratory underwent review by a respiratory doctor ('intervention laboratory') while requests at the second laboratory were not reviewed ('control laboratory'). The appropriateness of requests was measured against pre-specified criteria.
  
  
  RESULTS
  PFT requests for 335 subjects were included in the study. In the intervention laboratory, 8 of 110 ALV and 122 of 134 DLCO requests fulfilled pre-specified criteria for appropriate test indications. Fewer ALV (7% vs. 100%, p < 0.001) and DLCO tests (91% vs. 100%, p = 0.031) could have been performed in the intervention laboratory compared to the control laboratory.
  
  
  CONCLUSIONS
  A considerable proportion of 'complete' PFT requests from non-respiratory hospital doctors may be unwarranted. Using a simple screening method, the number of unnecessary PFTs could be reduced, resulting in substantial time and cost savings for hospital PFT laboratories.
authors.affiliation: a Department of Respiratory Medicine , Gold Coast University Hospital , Southport , Australia.|b School of Medicine, Parklands Drive , Griffith University , Southport , Australia.
authors.forename: Krishna Bajee
authors.initials: KB
authors.lastname: Sriram
authors.affiliation: a Department of Respiratory Medicine , Gold Coast University Hospital , Southport , Australia.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Fountain
authors.affiliation: a Department of Respiratory Medicine , Gold Coast University Hospital , Southport , Australia.
authors.forename: Jessica
authors.initials: J
authors.lastname: Hockenhull
authors.affiliation: a Department of Respiratory Medicine , Gold Coast University Hospital , Southport , Australia.
authors.forename: Debbie
authors.initials: D
authors.lastname: Zagami
mesh_terms: D020445:Hospitalists / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D000069342:Medical Overuse / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012129:Respiratory Function Tests / Q000706:statistics & numerical data*; D013147:Spirometry
keywords: Pulmonary function tests; appropriateness review; clinical services; health care quality; hospitalists