An administrative intervention to improve the utilization of laboratory tests within a university hospital

Background. Improving the appropriateness of testing behavior and reducing the number of laboratory tests have been recognized as essential parts of quality improvement. Objective. To assess the effectiveness of an administrative and a short-term educational intervention aimed at reducing clinical biochemistry laboratory utilization. Design. An analysis comparing utilization of laboratory tests performed on in-patients before and after the intervention. Setting. Computerized database of all laboratory tests performed in Hadassah Ein Kerem Medical Center, Jerusalem, Israel during 1999–2003. Intervention. The administrative intervention included restricting available emergency laboratory tests and frequency of repeated orders. The educational measures included: discussion of the misuse of laboratory tests and its consequences with the hospital medical staff, and presentation of the new restrictive policy. A feedback of the intervention’s results was sent to the wards and reviewed with senior medical staff. Main outcome measures. Change in utilization (measured as rates per 100 hospital days) of clinical biochemistry tests by hospital division and by selected laboratory tests. Results. An overall reduction of 19% in laboratory tests (95% CI: 18.8–19.2%) was observed in the year after the intervention. Utilization decreased significantly in all the hospital’s medical divisions, within a range of 14.9–43.8%. During the intervention period, utilization of hematology tests was reduced by 7.6% ( P = 0.009). Statistically significant reductions were noted in the ordering of all 12 selected clinical biochemistry tests. Although the orders of total cholesterol decreased by 72.2%, the utilization of ‘high-volume’ tests, such as glucose and electrolytes, showed only a modest decrease (7.9% and 6.9%, respectively). Conclusions. The present study included all hospital medical staff and covered all the available clinical biochemistry tests. This rather simple and low-cost intervention resulted in significant reductions in clinical biochemistry test orders as well as in the ordering of hematological blood tests.