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Physicians' perceptions of laboratory costs in the intensive care unit. Hamilton Regional Critical Care Group
1Department of Medicine, McMaster University, Hamilton, Ontario.
Insights
Intensive Care Unit (ICU) physicians have poor awareness of blood test costs, with residents underestimating charges more than attendings. Most physicians believe excessive blood tests are ordered, indicating openness to practice changes.
Area of Science:
- Medical Economics
- Clinical Practice Management
- Laboratory Medicine
Background:
- Intensive Care Units (ICUs) consume significant hospital resources.
- Laboratory test ordering is a major contributor to ICU costs.
- Physician awareness of test costs is crucial for cost-effective resource allocation.
Purpose of the Study:
- To assess Intensive Care Unit (ICU) physicians' awareness of charges for common blood tests.
- To evaluate ICU physicians' perceptions regarding the motivation and appropriateness of their test ordering practices.
- To identify potential targets for interventions aimed at reducing unnecessary laboratory testing in the ICU.
Main Methods:
- A survey questionnaire was administered to attending physicians and Internal Medicine residents in four university-affiliated ICUs.
- The survey assessed physicians' estimates of charges for ten common laboratory tests.
- Physicians' perceptions of test ordering motivations, appropriateness, and resource utilization were also evaluated.
Main Results:
- Physicians demonstrated wide variability in their cost estimations for laboratory tests.
- Internal Medicine residents generally underestimated test charges, while attending physicians showed mixed accuracy.
- A significant majority (over 85%) of physicians believed that excessive blood tests were being performed in the ICU.
- Physicians acknowledged insufficient attention to anemia risks and cost implications in test ordering.
Conclusions:
- ICU physicians exhibit limited awareness of the charges associated with commonly ordered blood tests.
- A strong consensus exists among ICU physicians that test ordering is excessive.
- Findings suggest a potential receptiveness among physicians to interventions aimed at optimizing laboratory test utilization and reducing healthcare costs.
Abstract:
Our objective was to determine the extent to which Intensive Care Unit (ICU) physicians are aware of charges for commonly used blood tests. We also wished to ascertain ICU physicians' perception of their motivation for, and appropriateness of, test ordering. Attending physicians and Internal Medicine residents in four university-affiliated ICUs in Hamilton were surveyed using a self-administered questionnaire. The response rate for the questionnaire was 91%. Physicians varied widely in their estimates of charges for ten laboratory tests. On average, residents tended to underestimate charges, while attending physicians sometimes underestimated, and sometimes overestimated. When all ten tests were considered, the mean estimates of the housestaff were lower than the ICU attending physicians (p < 0.001). Overall, attending estimates were 29.5% higher. Over 85% of physicians felt that too many blood tests were being performed. Physicians perceived that they pay insufficient attention to the risk of anemia and to issue of cost. Their feeling that test ordering in the ICU is excessive suggests that they may be open to modifying their practice. Given the large proportion of hospital resources allocated to the intensive care unit, interventions to decrease test ordering are warranted.