Spiegel J S, Shapiro M F, Berman B, Greenfield S
Department of Medicine, UCLA.
Arch Intern Med. 1989 Mar;149(3):549-53.
To decrease inappropriate test ordering by medical house staff in a university hospital, we examined the feasibility of an intervention that involved physicians in developing explicit criteria for ordering four specific tests and incorporated feedback of tests ordered. We implemented a time series design with measures at 12 and six months before, during, and three weeks after the intervention. During the intervention, orders for initial or admission chest roentgenograms decreased by 22% and repeated orders for routine urinalyses, chest roentgenograms, and leukocyte differential counts decreased by 23%, 30%, and 46%, respectively, compared with the six-month preintervention period. Orders for prothrombin time and/or partial thromboplastin time did not fall. After the intervention, most test ordering remained at the intervention level. These preliminary results suggest that this intervention may be effective and not overly costly.
为减少大学医院内科住院医师不恰当的检查医嘱，我们研究了一项干预措施的可行性，该措施让医生参与制定四项特定检查的明确医嘱标准，并纳入所开检查的反馈。我们采用了时间序列设计，在干预前12个月和6个月、干预期间以及干预后三周进行测量。与干预前六个月相比，干预期间，初次或入院时胸部X光检查的医嘱减少了22%，常规尿液分析、胸部X光检查和白细胞分类计数的重复医嘱分别减少了23%、30%和46%。凝血酶原时间和/或部分凝血活酶时间的医嘱没有下降。干预后，大多数检查医嘱维持在干预时的水平。这些初步结果表明，这项干预措施可能有效且成本不会过高。
