Inappropriate use of laboratory services: long term combined approach to modify request patterns

Abstract

Objective: To see whether changes in request patterns for haematological tests could be influenced in the long term by information released from a haematology department.

Design: Analysis of request patterns by hospital divisions before and after intervention and of costs of intervention and savings achieved.

Setting: Haematology laboratory of an inner city district general hospital.

Interventions: Monthly release of a comparison of clinicians' workload statistics, issue of on call guidelines, and promulgation of information (by seminars and factsheets) on appropriate use of tests.

Main outcome measures: Request patterns before and after intervention.

Results: During the year after intervention requests fell by at least a fifth, and the reduction persisted over the next two years. The reduction was most pronounced in relation to inpatients within the division of medicine, for whom requests fell from an average of 4.0 per patient in the six months before intervention to 2.9 per patient in the six months after.

Conclusions: A definite and sustained reduction in inappropriate requests for laboratory investigations may be achieved by an ongoing policy of intervention including issuing guidelines and factsheets and holding seminars, but a positive attitude among senior consultant staff is crucial.