New York University Langone Medical Center, New York.
New York University Langone Medical Center, New York.
Am J Med. 2016 Feb;129(2):215-20. doi: 10.1016/j.amjmed.2015.09.009. Epub 2015 Oct 23.
The purpose of this study is to decrease overutilization of laboratory testing by eliminating a feature of the electronic ordering system that allowed providers to order laboratory tests to occur daily without review.
We collected rates of utilization of a group of commonly ordered laboratory tests (number of tests per patient per day) throughout the entire hospital from June 10, 2013 through June 10, 2015. Our intervention, which eliminated the ability to order daily recurring tests, was implemented on June 11, 2014. We compared pre- and postintervention rates in order to assess the impact and surveyed providers about their experience with the intervention.
We examined 1,296,742 laboratory tests performed on 92,799 unique patients over 434,059 patient days. Before the intervention, the target tests were ordered using this daily recurring mechanism 33% of the time. After the intervention we observed an 8.5% (P <.001) to 20.9% (P <.001) reduction in tests per patient per day. The reduction in rate for some of the target tests persisted during the study period, but not for the 2 most commonly ordered tests. We estimated an approximate reduction in hospital costs of $300,000 due to the intervention.
A simple modification to the order entry system significantly and immediately altered provider practices throughout a large tertiary care academic center. This strategy is replicable by the many hospitals that use the same electronic health record system, and possibly, by users of other systems. Future areas of study include evaluating the additive effects of education and real-time decision support.
本研究旨在通过消除电子医嘱系统中的一个功能，减少实验室检查的过度使用，该功能允许医生无需审核即可每日重复开具实验室检查医嘱。
我们收集了一组常用实验室检查（每位患者每天的检查次数）在整个医院的使用情况，时间跨度为 2013 年 6 月 10 日至 2015 年 6 月 10 日。我们于 2014 年 6 月 11 日实施了干预措施，消除了每日重复开具检查医嘱的能力。我们比较了干预前后的使用率，以评估其影响，并调查了医生对干预措施的体验。
我们共检查了 92799 位患者的 1296742 次实验室检查，涉及 434059 个患者日。在干预前，目标检查中有 33%通过这种每日重复的机制开具医嘱。干预后，我们观察到每位患者每天的检查次数减少了 8.5%（P<.001）至 20.9%（P<.001）。在研究期间，一些目标检查的检查率下降持续存在，但最常开具的两种检查除外。我们估计，由于该干预措施，医院的成本减少了约 30 万美元。
对医嘱录入系统进行简单的修改，可立即显著改变大型三级保健学术中心的医生的实践行为。许多使用相同电子病历系统的医院，以及可能使用其他系统的医院，都可以复制这种策略。未来的研究领域包括评估教育和实时决策支持的附加效果。
