Cessation of dipstick urinalysis reflex testing and physician ordering behavior

Area of Science:

• Clinical chemistry
• Laboratory medicine
• Diagnostic testing

Background:

• Laboratory-initiated reflex testing is a common practice for initial urinalysis.
• Changes in laboratory protocols can impact physician diagnostic test ordering behavior.
• Understanding physician ordering patterns is crucial for optimizing laboratory resource utilization.

Purpose of the Study:

• To evaluate the impact of discontinuing laboratory-initiated reflex urinalysis testing on physician ordering practices.
• To assess changes in the utilization of microscopic urinalysis following a policy change.

Main Methods:

• A retrospective analysis of laboratory data was conducted over a 10-year period following the intervention.
• Data included urinalysis dipstick tests, microscopic analysis, and urine cultures, extracted from the laboratory information system.
• Physician complaints related to testing were also recorded.

Main Results:

• Microscopic urinalysis, previously performed on 17.9% of urinalysis tests (19,006/106,000 per 6 months), decreased to less than 0.2% after the policy change.
• Physician requests for microscopic urinalysis showed a gradual decline, stabilizing at approximately 50 per 6-month period over the decade.
• No significant increase in physician complaints was noted.

Conclusions:

• The elimination of laboratory-initiated reflex testing effectively reduced the performance of microscopic urinalysis.
• Physician ordering behavior adapted to the new policy, with a substantial decrease in direct requests for microscopic analysis.
• This intervention demonstrates a successful strategy for controlling the utilization of specific laboratory diagnostic tests.