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From process to policy: a generic prescription for test over-utilization in the emergency department
1Family Medicine Residency Program, University of Rochester and Highland Hospital, NY 14620.
Insights
This study found that patient age and severity influence diagnostic test ordering in emergency departments. An intervention significantly reduced excessive testing, leading to substantial cost savings.
Area of Science:
- Healthcare Management
- Clinical Diagnostics
- Health Economics
Background:
- Diagnostic test utilization in emergency departments is a significant cost driver.
- Identifying determinants of test ordering is crucial for optimizing resource allocation.
- Previous studies have not fully elucidated factors influencing excessive testing in this setting.
Purpose of the Study:
- To assess the determinants of diagnostic test ordering in an emergency department.
- To evaluate the impact of an intervention aimed at reducing test utilization.
- To quantify the potential cost savings associated with reduced excessive testing.
Main Methods:
- Retrospective chart review of 30 patients to identify determinants of test ordering.
- Prospective audit of 60 patient records after an administrative intervention.
- Consensus criteria for excessive testing defined and applied by physician reviewers.
Main Results:
- One-third of all diagnostic tests were initially judged as excessive.
- Patient age and severity were significantly associated with test ordering behavior.
- Following the intervention, a significant reduction in both overall and excessive test ordering was observed (p < .05).
Conclusions:
- Administrative changes informed by audit findings can effectively reduce excessive laboratory testing.
- Targeted interventions can lead to significant cost savings in diagnostic test utilization.
- Optimizing diagnostic test ordering is achievable through policy adjustments and physician awareness.
Abstract:
Patients presenting to a community hospital emergency department were studied retrospectively to assess the determinants of diagnostic test ordering, and prospectively following an intervention to reduce test utilization. Records of thirty patients were selected for detailed physician review. Consensus criteria for excessive testing were defined by four physician reviewers and applied to each record. One third of all tests were judged excessive. Of multiple demographic and clinical variables studied, only patient age and severity were related to test ordering behavior. Six months after an administrative change caused by review of these findings, a repeat audit of sixty patient records revealed significantly fewer tests ordered (p less than .05) and significantly fewer excessive tests (p less than .05). The projected annual savings in laboratory charges for these patients were $14,838. Simple distribution of the base-year findings, by assisting a change in policy, have effected substantial reductions in excessive laboratory testing.