Lapić Ivana, Juroš Gordana Fressl, Rako Ivana, Rogić Dunja
Department of Laboratory Diagnostics, University Hospital Center Zagreb, Kišpatićeva 12, 10 000 Zagreb, Croatia.
Department of Laboratory Diagnostics, University Hospital Center Zagreb, Kišpatićeva 12, 10 000 Zagreb, Croatia.
Int J Med Inform. 2017 Jun;102:29-34. doi: 10.1016/j.ijmedinf.2017.03.002. Epub 2017 Mar 8.
Appropriate laboratory utilization more often than not needs to be initiated by the laboratory. This study was performed to analyze the impact on test ordering patterns in the emergency department obtained by omitting certain tests from the electronic tick box request form. The tests could still be ordered by writing the full name of the test or by a phone call.
Erythrocyte sedimentation rate (ESR), fibrinogen, aspartate aminotransferase (AST), calcium and lipase were omitted from the electronic request form and could subsequently be ordered either by phone or a typed-in request. A reflex testing protocol was elaborated for reduction of creatine kinase (CK) and CK-MB analyses. All interventions were introduced with prior consultation with clinical staff and according to current guidelines. The reduction of test orders and costs in the post-intervention period was assessed. All data were retrieved retrospectively from the laboratory information system (LIS).
Disappearance from the tick box request form resulted in a significant decrease in the number of requests for targeted tests in the post-intervention year, mostly affecting AST and fibrinogen (83% and 79% reduction of ordering, respectively), followed by a 58% reduction in calcium orders, and 54% and 43% reductions in ESR and lipase requests, respectively. A substantial reduction in CK requests was also observed, while CK-MB requests almost disappeared. Annual cost savings that emerged from all implemented interventions were estimated to be 19,445€.
Significant reduction in ordering of selected tests was achieved simply by limiting their availability in hospital computerized order entry (COE) system. The present data suggest that removal of laboratory tests from the electronic request form can be an effective tool for changing physicians' test ordering behavior.
通常情况下，实验室需要率先推动合理利用实验室检查。本研究旨在分析通过从电子勾选框申请表中省略某些检查项目，对急诊科检查申请模式产生的影响。这些检查项目仍可通过书写检查全名或打电话的方式进行申请。
将红细胞沉降率（ESR）、纤维蛋白原、天冬氨酸转氨酶（AST）、钙和脂肪酶从电子申请表中省略，随后可通过电话或键入申请的方式进行申请。制定了一项反射性检查方案以减少肌酸激酶（CK）和CK-MB分析。所有干预措施均在与临床工作人员事先协商并根据现行指南的情况下引入。评估干预后时期检查申请数量和成本的减少情况。所有数据均从实验室信息系统（LIS）中进行回顾性检索。
勾选框申请表中某些检查项目的消失导致干预后一年中目标检查申请数量显著减少，主要影响AST和纤维蛋白原（申请量分别减少83%和79%），其次是钙申请量减少58%，ESR和脂肪酶申请量分别减少54%和43%。CK申请量也大幅减少，而CK-MB申请几乎消失。所有实施干预措施带来的年度成本节约估计为19445欧元。
仅通过限制医院计算机化医嘱录入（COE）系统中某些检查项目的可用性，就实现了所选检查申请量的显著减少。目前的数据表明，从电子申请表中删除实验室检查项目可以成为改变医生检查申请行为的有效工具。
