Effect of "standard order" deletion on emergency department coagulation profile use

To determine whether the test ordering of physicians working in a teaching hospital emergency department could be influenced by modification of automated laboratory order sets.

Prospective, using data from the same ED before and after intervention.

A 58,000-visit public university hospital ED.

Emergency physicians caring for adult patients admitted from the ED to the ward medical services.

Beginning July 1, 1989, coagulation studies were deleted from the automated admission order sets used in the study hospital ED.

Patient charts were examined to assess the effect of coagulation study deletion on the frequency and appropriateness of coagulation test ordering. A tripling of the percentage of patients who did not receive coagulation parameter testing was noted (P less than .0001, chi 2). In no case were the tests omitted when a high-yield indication for their use was present. This resulted in an estimated reduction of $20,000 per year in patient charges.

Modification of ED "standard orders" can result in reduction of laboratory use without an adverse effect on patient care.