Effect of automated test rejection on repeat requesting

Abstract

We present our experience of automated test rejection and computerised reminders on hospital clinicians (HCs') and general practioners (GPs') repeat requesting behaviour. In 2000 four tests (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 lab database in 2001. The data supported the contention that tests are being unnecessarily repeated. Re-audit after four 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 four 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 and benefit on requesting behaviour from continuous computerised reminders about appropriate test repetition intervals.