Test ordering guidelines can alter ordering patterns in an academic emergency department.

Area of Science:

• Emergency Medicine
• Health Services Research
• Medical Education

Background:

• Unnecessary laboratory test ordering in Emergency Departments (EDs) contributes to increased healthcare costs.
• Standardizing test ordering practices is crucial for efficient patient care and resource allocation.
• Educational interventions are a potential strategy to influence physician behavior regarding diagnostic testing.

Purpose of the Study:

• To evaluate the impact of an educational program on laboratory test ordering behavior in an academic Emergency Department (ED).
• To assess the economic consequences of modified test ordering practices following the educational intervention.

Main Methods:

• An observational, before-and-after study design was employed at a university tertiary referral center and Emergency Medicine (EM) residency site.
• Evidence-based test ordering standards were developed and disseminated to all ED staff, including residents and medical students.
• No restrictions were placed on actual test ordering; the intervention focused solely on education.

Main Results:

• A significant decrease was observed in the frequency of total laboratory tests, complete blood count (CBC), and liver function tests (LFTs) ordered per 100 patients after the educational program.
• While prothrombin time and blood culture ordering showed no significant change, chemistry test ordering frequency significantly increased.
• The intervention resulted in an approximate cost saving of $50,000.

Conclusions:

• Test ordering behavior in an academic ED can be effectively modified through a targeted educational program.
• Educational interventions demonstrate the potential for significant economic impact by optimizing laboratory test utilization.
• Sustained modification of clinical practices through education is achievable and can lead to cost-effective healthcare delivery.