The effect of a gold coin fine on C-reactive protein test ordering in a tertiary referral emergency department.

Objective: To examine the effect of an education campaign based around a gold coin fine on ordering of C-reactive protein (CRP) tests.

Design And Setting: A retrospective analysis of CRP test ordering before and after the intervention in the emergency department (ED) of a tertiary referral hospital in metropolitan Sydney that sees about 60,000 patients per annum. The date of the intervention - 2 August 2013 - corresponded with Jeans for Genes Day.

Main Outcome Measures: Number of CRP tests ordered in the ED.

Results: 1290 CRP tests were ordered before the intervention (1-31 July), and 394 were ordered after the intervention (2-31 August). This decrease in CRP test ordering was despite an increased number of ED presentations in August compared with July (5219 v 5497 presentations). This represented an absolute reduction in the rate of CRP test ordering of 17.6% (95% CI, 16.2%-18.9%; P < 0.001).

Conclusion: The threat of a gold coin fine for ordering a CRP test, as part of a broader education campaign, significantly reduced the number of CRP tests ordered in a tertiary referral ED.