How should excess admission laboratory test utilization be curtailed?

Paediatricians' preferences

Brian M. Feldman
Derek Stephens
Elaine E.L. Wang

Divisions of Rheumatology, Infectious Diseases and the Clinical Epidemiology Unit, Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario

(Original manuscript submitted 17/3/94; received in revised form 14/6/95; accepted 10/7/95)

Abstract

Routine admission casefinding tests are costly and rarely lead to changes in management. Strategies have been proposed to decrease them. However, it is unclear which tests are considered routine at admission. Our objectives were to clarify which tests are considered to be routine and to determine which methods of reducing test utilization are most acceptable. Sixty-five physicians from a paediatric teaching hospital were selected by random stratified sampling. A questionnaire was administered asking about the role of routine tests and preferences for 6 strategies to reduce test ordering. Sixty percent of respondents felt that more casefinding was occurring than should be, and 89% would agree to a trial of test reduction strategies. Just over half the respondents felt that hemoglobin determination and urinalysis were routine admission tests; fewer physicians listed a wide variety of other tests. Physicians who thought that all admissions should be screened were older, graduated earlier, and tended to be community based. Educational strategies to reduce testing were more acceptable than administrative ones. We conclude that many physicians would support the trial implementation of test reduction strategies in childrens' hospitals. Hospitals wishing to reduce excess admission casefinding should implement educational strategies, as physicians prefer these.

Clin Invest Med 1995; 18 (6): 502-509

Table of contents: CIM vol. 18, no. 6