Impact of sharing laboratory test costs and required blood volumes on resident test ordering

Abstract

 Background and purpose: A significant proportion of inpatient laboratory testing is unwarranted and can lower quality of care, increase healthcare expenditures, and contribute to unnecessary investigations with their attendant comorbidities. This study investigates the relationship between the provision of information about costs and patient impact of laboratory testing, and resident ordering habits. 

Methods: Two independent four-week Internal Medicine resident blocks were studied. After two weeks, cost and blood volume information was distributed to residents during a 10-minute intervention. Pre- and post-intervention resident surveys measuring importance and influence of the intervention information were conducted. The daily number of blood collections and tests ordered, normalized to patient admission volumes, were analyzed by interrupted time-series analysis.

Results: There was no significant effect of the intervention on resident test ordering. Despite this, 74% (N=34) and 63% (N=29) of pre-intervention responses predicted that cost and blood volume information respectively, would impact their ordering. All post-intervention responses (N=46) stated that these factors had influenced their ordering. Residents were unaware of the intervention information beforehand and demonstrated limited retention.

Conclusions: This study design illustrates a disparity between observed resident test ordering habits and their belief that the intervention altered their ordering practices. Education on cost and blood volumes, by distribution of pamphlet, did not influence resident test ordering demonstrating that interventions to reduce non-specific test ordering should utilize an alternative educational approach.

Keywords: Inappropriate testing, medical education, diagnostic stewardship, resident education