van der Horst Armando, van de Wijngaart Dennis J, Scherrenburg Jolanda, van Dijk Nadine, Janssens Pim M W
.
Clin Chem Lab Med. 2017 Aug 28;55(10):1523-1529. doi: 10.1515/cclm-2016-1092.
Laboratory test ordering under time pressure may impact test-ordering behavior.
To investigate the test-ordering behavior of doctors working under such pressure, we designed a questionnaire for trainees and staff in the Emergency Department (ED). This questionnaire addressed topics such as necessity of requested tests, time spent on ordering, costs and availability of tests, and the time of the day. We hypothesized that ordering behavior would be guided predominantly by the medical need of tests and aimed at identifying practical motives that also have an effect.
Remarkably, two-third of the respondents (67%) admitted that tests were ordered that would not influence treatment policy directly and 48% of the doctors stated that tests were ordered that do not impact treatment at all. The frequency of such orders was "sometimes" and "frequent" in a 50:50 ratio. Interestingly, tests that could prove relevant at a later stage are often ordered simultaneously to reduce burden on the patient. None of the respondents spent more than 3 min on the ordering process and very few (8%) desired more time for ordering. Most respondents (81%) declared to have limited knowledge of the costs of laboratory tests. A random survey covering four tests confirmed this. Generally, turnaround time did influence ordering behavior while time of the day did not.
In conclusion, doctors in an ED - besides first of all medical motives - heavily exploit practical (non-medical) reasoning for laboratory test ordering, e.g. taking availability of tests into account and ordering non-immediate tests.
在时间压力下进行实验室检查的医嘱开具可能会影响检查医嘱的行为。
为了调查在这种压力下工作的医生的检查医嘱行为，我们为急诊科的实习生和工作人员设计了一份问卷。该问卷涉及所要求检查的必要性、开具医嘱所花费的时间、检查的成本和可获得性以及一天中的时间等主题。我们假设医嘱行为将主要由检查的医疗需求引导，并旨在识别也有影响的实际动机。
值得注意的是，三分之二的受访者（67%）承认开具了不会直接影响治疗策略的检查医嘱，48%的医生表示开具了对治疗根本没有影响的检查医嘱。此类医嘱的频率为“有时”和“频繁”，比例为50:50。有趣的是，那些可能在后期被证明相关的检查通常会同时开具，以减轻患者的负担。没有受访者在开具医嘱过程中花费超过3分钟，很少有人（8%）希望有更多时间开具医嘱。大多数受访者（81%）宣称对实验室检查的成本了解有限。一项涵盖四项检查的随机调查证实了这一点。一般来说，周转时间确实会影响医嘱行为，而一天中的时间则不会。
总之，急诊科的医生——除了首先出于医疗动机外——在很大程度上利用实际（非医疗）推理来开具实验室检查医嘱，例如考虑检查的可获得性并开具非紧急检查医嘱。
