Using pathology-specific laboratory profiles in clinical pathology to reduce inappropriate test requesting: two completed audit cycles

Abstract

Background: Systematic reviews have shown that, although well prepared, the Consensus Guidelines have failed to change clinical practice. In the healthcare district of Castelnovo né Monti (Reggio Emilia, Italy), it became necessary for the GPs and Clinical Pathologists to work together to jointly define laboratory profiles.

Methods: Observational study with two cycles of retrospective audit on test request forms, in a primary care setting. Objectives of the study were to develop pathology-specific laboratory profiles and to increase the number of provisional diagnoses on laboratory test request forms. A Multiprofessional Multidisciplinary Inter-hospital Work Team developed pathology-specific laboratory profiles for more effective test requesting. After 8 training sessions that used a combined strategy with multifaceted interventions, the 23 General Practitioners (GPs) in the trial district (Castelnovo nè Monti) tested the profiles; the 21 GPs in the Puianello district were the control group; all GPs in both districts participated in the trial. All laboratory tests for both healthcare districts are performed at the Laboratory located in the trial district. A baseline and a 1-year audit were performed in both districts on the GPs' request forms.

Results: Seven pathology-specific laboratory profiles for outpatients were developed. In the year after the first audit cycle: 1) the number of tests requested in the trial district was distinctly lower than that in the previous year, with a decrease of about 5% (p < 0.001); 2) the provisional diagnosis on the request forms was 52.8% in the trial district and 42% in the control district (P < 0.001); 3) the decrease of the number of tests on each request form was much more marked in the trial district (8.73 vs. 10.77; p < 0.001).

Conclusions: The first audit cycle showed a significant decrease in the number of tests ordered only in the trial district. The combined strategy used in this study improved the prescriptive compliance of most of the GPs involved. The presence of the clinical pathologist is seen as an added value.

Figure 1

Number of tests ordered in Castelnovo né Monti trial district (dark gray bar) and in Puianello district (light gray bar) during the course of the year, from 2005 to 2008. The baseline audit was conducted in the year 2007 and the 2nd cycle of audits was completed in 2008.

Figure 2

Average number of laboratory tests ordered on a single request form during the course of the year, from 2005 to 2008. Dark gray line for the Castelnovo né Monti trial district; Light gray line for the Puianello control district.

Figure 3

Provisional diagnosis present on order forms. Dark gray bars for the Castelnovo né Monti trial district; Light gray bars for the Puianello control district. The baseline audit was conducted in the year 2007, and the 2nd cycle of audit was completed in 2008.