Background:
The literature suggests that stat laboratory tests are frequently ordered inappropriately by physicians. In fact, up to 65% of laboratory tests are ordered as stat in teaching hospitals. Previous studies also suggest that reporting of truly urgent test results can be delayed by overall excessive stat test ordering. Safe patient care delivery depends on timeliness of pertinent laboratory data. However, there are no published studies on any intervention that are consistently effective in decreasing stat laboratory test orders. Stat test orders consisted of nearly 50% of all laboratory test orders at our institution. The volume of stat tests ordered exceeded that of our sister institutions combined. This prompted us to explore an intervention to decrease stat test orders at our institution.
Purpose:
To identify stat test ordering patterns of physicians and to decrease the number of stat laboratory test orders at our institution.
Description:
We collected data on stat test orders by provider over a 1‐month period in December 2009. This data revealed that 50 of 488 physicians ordered 51.1% of stat tests. Medical and surgical residents accounted for 43 of the 50 physicians. These data identified our target physician group as medical and surgical residents. Based on this information, we created an interdisciplinary working group composed of medicine, surgery, and laboratory medicine to approach this problem. A survey was then distributed among medical and surgical residents to assess their perception of the stat test‐ordering process. The survey (n = 76) revealed that the frequency of ordering stat tests was variable among these physicians. Notably, 25% of them ordered laboratory tests as stat more than 95% of the time, and 73.6% reported that their stat laboratory test‐ordering frequency was appropriate. Medical and surgical residents were given a 1‐hour teaching session explaining the criteria for appropriate stat test‐ordering practice as well as data on their current practice following the survey. Based on provider‐based data, individual feedback from program directors of internal medicine and surgery was given to the 10 house staffers who most frequently ordered stat tests on a monthly basis from February to June 2010.
Conclusions:
The number of stat tests ordered by medical and surgical residents showed a downward trend after implementation of the intervention. Compared with the preintervention period (December 2009–January 2010), both the raw number of stat tests and the number of stat tests per admission ordered by medical and surgical residents significantly decreased during the intervention period (February–June 2010) by 18% and 21%, respectively (P < 0.05). Given the wide variety of stat test ordering patterns and the perception of residents, targeted individual feedback from program directors could be a promising approach to decreasing the number of stat test orders in teaching hospitals.
Disclosures:
A. Sorita ‐ none; D. Steinberg ‐ none; M. Leitman ‐ none; P. Luhan ‐ none; A. Burger ‐ none; L. Sivaprasad ‐ none