Impact of weekly feedback on test ordering patterns.

Area of Science:

• Medical Education
• Health Services Research
• Clinical Laboratory Science

Background:

• Laboratory overutilization is a significant concern in healthcare, contributing to increased costs and potential patient harm.
• Internal medicine residents' test-ordering behavior is a key area for performance improvement initiatives.
• Effective strategies are needed to curb unnecessary laboratory testing in academic medical centers.

Purpose of the Study:

• To evaluate the impact of weekly feedback reports on laboratory test ordering by internal medicine residents.
• To assess the effectiveness of a performance improvement intervention aimed at reducing test overutilization.
• To determine if peer comparison feedback can modify physician test-ordering behavior.

Main Methods:

• Retrospective analysis of laboratory test ordering data from internal medicine residents at an urban academic medical center.
• Intervention involved an educational seminar on laboratory overutilization followed by weekly feedback reports comparing individual resident ordering patterns to group averages.
• Statistical comparison of test ordering volumes between pre-intervention and post-intervention phases using an independent t test.

Main Results:

• A 21% net reduction in laboratory tests ordered was observed during the post-intervention phase.
• This reduction translated to an average decrease of 941 tests per week.
• Significant cost savings of $1.3 million were realized, with the greatest reductions in chemistry and hematology testing.

Conclusions:

• Weekly comparative feedback reports are an effective strategy for reducing laboratory overutilization among physicians-in-training.
• This intervention successfully reduced test ordering without compromising physician autonomy or requiring infrastructure changes.
• The findings support the use of peer comparison feedback as a tool for promoting cost-effective laboratory utilization in medical education.