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Unnecessary out-of-hours biochemistry investigations--a subjective view of necessity
1Inverclyde Royal Hospital, Larkfield Road, Greenock.
Objective:
To investigate the extent to which pre-registration house officers (PRH0s) admit to requesting 'unnecessary' out-of-hours biochemistry tests and assess the reasons why this occurs.
Design:
Semi-structured interviews conducted over a 2-year period covering 1998/99.
Setting:
Inverclyde Royal District General Hospital
Subjects:
79 PRHOs.
Results:
Seventy-nine PRHOs were interviewed. Eighty-seven percent admitted requesting 'unnecessary' out-of-hours tests in between 5% and 50% of cases. The reasons cited include uncertainty about the diagnosis (80%), the need for medico-legal protection (79%), to avoid leaving work for colleagues (66%), and to prevent criticism from consultant staff and others (71%). Seventy six percent of PRHOs indicated that ordering 'unnecessary' tests helped to lessen anxiety and reduce stress levels associated with their work. Seventy one percent agreed an attempt should be made to reduce 'unnecessary' tests.
Conclusions:
This study has shown that a significant proportion of PRHOs admits to requesting 'unnecessary' out-of-hours tests. A better understanding of why these tests are requested has been established. The need for self-protection and a fear of criticism from senior staff are prominent factors affecting stress levels amongst junior medical staff in the hospital workplace.