Section General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Department of Clinical Chemistry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Clin Chem Lab Med. 2022 Dec 19;61(3):412-418. doi: 10.1515/cclm-2022-0946. Print 2023 Feb 23.
Inappropriate use of laboratory testing remains a challenging problem worldwide. Minimum retest intervals (MRI) are used to reduce inappropriate laboratory testing. However, their effectiveness and the usefulness in reducing inappropriate laboratory testing is still a matter of debate. The aim of this study was to evaluate the effectiveness of broadly implemented MRIs as a means of reducing inappropriate laboratory test requests.
We performed a retrospective study in a general care and teaching hospital in the Netherlands, where MRI alerts have been implemented as standard care since June 7th 2017. Clinical chemistry test orders in adult internal medicine patients placed between July 13th 2017 and December 31st 2019 were included. The primary outcome was the effectiveness of MRIs, expressed as percentages of tests ordered and barred as a result of MRIs.
Of a total of 218,511 test requests, 4,159 (1.90%) got an MRI alert. These MRIs were overruled by physicians in 21.76% of the cases. As a result of implementing MRIs, 3,254 (1.49%) tests were barred. The financial savings for the department of internal medicine directly related to the included barred laboratory tests during this period were 11,880 euros on a total amount of 636,598 euros for all performed tests.
Only a small proportion of laboratory tests are barred after implementation of MRIs, with a limited impact on the annual costs. However, MRIs provide a continuous reminder to focus on appropriate testing and the effectiveness of MRIs is potentially higher than described in this study.
实验室检测的不当使用仍是全球面临的一大挑战。最小复查间隔（MRI）用于减少不适当的实验室检测。然而，其有效性以及在减少不适当实验室检测方面的实用性仍存在争议。本研究旨在评估广泛实施 MRI 作为减少不适当实验室检测请求的手段的有效性。
我们在荷兰的一家普通护理和教学医院进行了回顾性研究，自 2017 年 6 月 7 日起，MRI 警报已作为标准护理实施。纳入 2017 年 7 月 13 日至 2019 年 12 月 31 日期间成人内科患者的临床化学检测订单。主要结局是 MRI 的有效性，以因 MRI 而被要求和被禁止的检测百分比表示。
在总共 218511 次检测请求中，有 4159 次（1.90%）收到 MRI 警报。这些 MRI 中有 21.76%的情况被医生推翻。由于实施了 MRI，有 3254 次（1.49%）检测被禁止。在此期间，与所包括的被禁止的实验室检测直接相关的内科部门的财务节省为 11880 欧元，而所有进行的检测总金额为 636598 欧元。
实施 MRI 后，只有一小部分实验室检测被禁止，对年度成本的影响有限。然而，MRI 不断提醒人们关注适当的检测，并且 MRI 的有效性可能高于本研究中描述的。
