The effect of automated test rejection on repeat requesting

We present our experience of the effect of automated test rejection and computerised reminders on repeat requesting behaviour of hospital clinicians and general practioners. In 2000, four tests (thyroid-stimulating hormone (TSH), ferritin, glycated haemoglobin and B12 + folate), which are frequently requested, were selected. Following discussion with key local clinicians, test-specific trigger intervals within which a repeat was unlikely to show clinical change were decided. A computerised scheme of automatic test rejection was introduced in 2000 and the effect on these four tests assessed by retrospective interrogation of the laboratory database in 2001. The data supported the contention that tests are being unnecessarily repeated. Re-audit after 4 years looked at the effect of these reminders on physician repeat requesting practice. Against a background increased workload of 37.4% for these tests over the 4-year period, the mean percentage of declined tests fell from 4.0% in 2001 to 2.8% in 2005. This suggests a positive learning effect on requesting behaviour from continuous computerised reminders about appropriate test repetition intervals.

Introduction

The appropriate use of laboratory tests is necessary for optimal patient care. Laboratory utilisation has steadily increased during the past several decades in many health care jurisdictions around the world.^1,2 Inappropriate requesting can make up a large proportion of laboratories’ workloads and cost the health care system significant amounts of money. There have been numerous attempts over the years …