Continuous improvement, quality control, and cost containment in clinical laboratory testing. Enhancement of physicians' laboratory-ordering practices.

In 1991, the University of Massachusetts Medical Center, in Worcester, developed a model for change by using a program of continuous quality improvement to enhance physicians' laboratory-ordering practices, particularly the test for bleeding times. We describe a model that was developed through a seven-step continuous quality improvement process, and we discuss our success in increasing the appropriateness of ordering the tests for bleeding times while significantly reducing the costs for patients and hospitals. The following factors contributed to the program's success: an advisory structure; presentations to the medical staff; focused feedback sessions; and most important, well-documented guidelines with institutional support for new behavior.