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Impact of an Educational Intervention on Adherence to Minimum Laboratory Re-testing Intervals (MRTI) Among Internal
Sekar Dineshbabu1, Debasis Naik2, Ramadoss Ramu1
1Internal Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND.
Abstract:
Background Overuse of repeat laboratory testing contributes to increased healthcare costs and patient burden, particularly in teaching hospitals where test ordering is often trainee-driven. Minimum re-testing intervals (MRTI) have been proposed as a strategy to reduce unnecessary investigations, but adherence remains suboptimal. Methods We conducted a quasi-experimental before-and-after study in the Department of Medicine of a tertiary care teaching hospital in South India. A structured educational intervention incorporating MRTI guidance was delivered to internal medicine residents. Medical records of hospitalised patients with a stay of more than or equal to five days were reviewed during pre-intervention (November 2025) and post-intervention (January 2026) periods. The primary outcome was adherence to MRTI recommendations. Comparisons were made using the chi-square test, with results reported as absolute differences with 95% confidence intervals (CI). Results A total of 863 and 824 laboratory tests were analysed in the pre- and post-intervention phases, respectively. Overall adherence to MRTI improved from 58.9% to 65.9%, corresponding to an absolute increase of 7.0% (95% CI: 2.4% to 11.6%; χ² = 8.68, p = 0.003). Improvements were observed across most test categories, with the largest increase seen in complete blood count (CBC) testing (+28.3%). Significant gains were also noted for renal function tests, electrolytes, and calcium-magnesium panels. In contrast, liver function tests showed no statistically significant improvement. Total testing volume decreased modestly without a reduction in testing intensity per patient. Conclusions A brief, structured educational intervention significantly improved adherence to recommended laboratory re-testing intervals, particularly for frequently ordered investigations. These findings support the role of targeted educational strategies as a pragmatic and scalable approach to improving laboratory stewardship in resource-constrained teaching hospitals, although test-specific and system-level interventions may be required for sustained impact.
Insights
A targeted educational intervention improved adherence to minimum re-testing intervals (MRTI) for laboratory tests in a teaching hospital. This strategy enhances laboratory stewardship and reduces healthcare costs by optimizing test ordering practices.
Area of Science:
- Medical Education
- Health Services Research
- Clinical Pathology
Background:
- Overuse of repeat laboratory testing increases healthcare costs and patient burden, especially in teaching hospitals.
- Minimum re-testing intervals (MRTI) are recommended to curb unnecessary investigations, but adherence is often poor.
- Trainee-driven test ordering significantly contributes to suboptimal adherence in academic medical settings.
Purpose of the Study:
- To evaluate the impact of a structured educational intervention on adherence to MRTI among internal medicine residents.
- To assess the effectiveness of MRTI guidance in reducing unnecessary laboratory testing in a tertiary care teaching hospital.
- To identify specific laboratory test categories that benefit most from improved adherence to re-testing intervals.
Main Methods:
- A quasi-experimental before-and-after study was conducted in a tertiary care teaching hospital in South India.
- Internal medicine residents received a structured educational intervention focused on MRTI guidance.
- Medical records of hospitalized patients (≥5 days stay) were reviewed pre- and post-intervention to measure adherence.
Main Results:
- Overall adherence to MRTI increased from 58.9% to 65.9% post-intervention (absolute increase of 7.0%).
- Significant improvements were observed in complete blood count (CBC) testing (+28.3%), renal function tests, and electrolytes.
- While total testing volume decreased modestly, liver function test adherence showed no significant improvement.
Conclusions:
- A brief educational intervention effectively enhanced adherence to laboratory re-testing intervals, particularly for common tests.
- Targeted educational strategies offer a pragmatic approach to improving laboratory stewardship in resource-constrained teaching hospitals.
- Sustained impact may necessitate test-specific and broader system-level interventions beyond education alone.
