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Retrospective analysis of serologic test requests in the diagnosis of viral hepatitis: Inappropriate test requests
Melahat Gürbüz1, Gülcan Gencer2
1Department of Medical Microbiology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey.
Insights
Inappropriate viral hepatitis serology tests cost $3309.00, driven by physician fears of malpractice and diagnostic errors. Educating clinicians on rational laboratory use is key to reducing these unnecessary medical tests.
Area of Science:
- Medical Diagnostics
- Health Economics
- Laboratory Medicine
Background:
- Rational laboratory use and standardized test ordering procedures are crucial for minimizing unnecessary diagnostic tests.
- Inappropriate test requests contribute to increased healthcare costs and inefficient resource allocation.
Purpose of the Study:
- To quantify the financial burden of inappropriate viral hepatitis serology test requests.
- To investigate the underlying reasons for physicians' unnecessary test ordering practices.
Main Methods:
- A retrospective analysis of inappropriate hepatitis serology test requests and their associated costs over one year at a tertiary care hospital.
- A survey of 135 physicians across 23 departments to identify reasons for unnecessary test requests.
Main Results:
- The study identified 2183 (3.84%) inappropriate test requests, totaling $3309.00 in costs.
- Inappropriate requests were linked to factors such as unit type, service location (inpatient/outpatient), and physician's professional title.
- Physicians cited fear of malpractice and diagnostic errors as primary reasons for unnecessary testing, often due to a lack of familiarity with diagnostic algorithms and rational laboratory use.
Conclusions:
- Unnecessary laboratory testing, particularly in viral hepatitis serology, imposes a significant financial burden and operational inefficiency.
- Physician education on diagnostic algorithms, rational test ordering, and cost awareness is essential for improving laboratory test utilization.
- Implementing targeted interventions, including in-service training, can help reduce inappropriate test requests and optimize healthcare resource management.
Abstract:
The rational laboratory use and implementation of test ordering procedures aim to reduce unnecessary test requests. This study aimed to determine the financial burden caused by inappropriate serological test requests for viral hepatitis and to investigate physicians' reasons for making unnecessary test requests. We performed a retrospective evaluation of inappropriate requests for hepatitis serology testing and the financial burden they caused at a tertiary care hospital over a 1-year period. The study found 2183 (3.84%) inappropriate test requests, costing $3309.00. Of these, 357 were same-day repeat requests and 1826 were requests not following diagnostic algorithms. In the logistic regression analysis of the factors affecting unnecessary test requests, a statistically significant difference was found between whether the unit was internal or surgical, whether the request came from inpatient services or outpatient clinics, and the professional titles (P < .05). Both types of inappropriate requests were more common among male physicians (P < .05). The highest rates of inappropriate test requesting were in physical therapy and rehabilitation, pediatrics, and adult emergency units. To identify the reasons behind unnecessary test requests, 135 physicians from 23 different departments participated in the survey. The main reasons for requesting tests were identified as protecting against malpractice and fears of misdiagnosis or overlooking a diagnosis. It has been observed that physicians often order tests routinely, without being fully familiar with standard test ordering procedures based on diagnostic algorithms, and lacking knowledge about rational laboratory use. The cost of tests is mostly unknown to clinicians. The study concludes that there are laboratory tests that incur much higher costs. When this assessment is applied to the entire laboratory, it becomes clear how significant a financial burden, unnecessary workload, and loss of time this situation can cause. Identifying the presence of unnecessary test requests is the first step in preventing them. Appropriate measures include highlighting these issues, providing necessary information, and offering in-service training.
