An administrative intervention to improve the utilization of laboratory tests within a university hospital.

Background: Improving the appropriateness of testing behavior and reducing the number of laboratory tests have been recognized as essential parts of quality improvement.

Objective: To assess the effectiveness of an administrative and a short-term educational intervention aimed at reducing clinical biochemistry laboratory utilization.

Design: An analysis comparing utilization of laboratory tests performed on in-patients before and after the intervention.

Setting: Computerized database of all laboratory tests performed in Hadassah Ein Kerem Medical Center, Jerusalem, Israel during 1999-2003.

Intervention: The administrative intervention included restricting available emergency laboratory tests and frequency of repeated orders. The educational measures included: discussion of the misuse of laboratory tests and its consequences with the hospital medical staff, and presentation of the new restrictive policy. A feedback of the intervention's results was sent to the wards and reviewed with senior medical staff.

Main Outcome Measures: Change in utilization (measured as rates per 100 hospital days) of clinical biochemistry tests by hospital division and by selected laboratory tests.

Results: An overall reduction of 19% in laboratory tests (95% CI: 18.8-19.2%) was observed in the year after the intervention. Utilization decreased significantly in all the hospital's medical divisions, within a range of 14.9-43.8%. During the intervention period, utilization of hematology tests was reduced by 7.6% (P = 0.009). Statistically significant reductions were noted in the ordering of all 12 selected clinical biochemistry tests. Although the orders of total cholesterol decreased by 72.2%, the utilization of 'high-volume' tests, such as glucose and electrolytes, showed only a modest decrease (7.9% and 6.9%, respectively).

Conclusions: The present study included all hospital medical staff and covered all the available clinical biochemistry tests. This rather simple and low-cost intervention resulted in significant reductions in clinical biochemistry test orders as well as in the ordering of hematological blood tests.