Medical stewardship: Pathology evidence based ordering to reduce inappropriate test ordering in a teaching hospital

Abstract

Objective: This study was designed as an educational program aimed at promoting evidence-based pathology ordering with the aim of reducing inappropriate test ordering.Methods: Researchers benchmarked the hospital’s pathology tests ordered in 2013-2014 before conducting a multifaceted education program in 2014-2015. The intervention consisted of main priorities including pathology test auditing, in-services and lectures, development and implementation of investigation pathways, and policy and procedure compliance. The main outcome measures was a reduction in commonly inappropriate ordered pathology testing leading to a reduction in the average test per hospital admission, and a reduction in specimen collection errors.Results: Through this educational method the researchers achieved a reduction in the average test per admission in 2014-2015 (M = 12.98) from 2013-2014 (M = 13.83). A two sample t-test indicated that this difference was significant, t(3.3006) = 0.0071, p = .01. The intervention included a focus on specimen collection errors and achieved a reduction in specimen error rates (M = 2,695) from the previous year (M = 3,000). A one sample t-test indicated that this difference was significant, t(3.0804) = 0.0105, p = .05. This intervention decreased commonly inappropriate pathology requests of Full Blood Count (FBC, -4.21%), Liver Function Tests (LFTs, -8.36%), Vitamin B12 (B12, -6.45%) and Coagulation profile (-21.22%). Commonly inappropriate pathology tests decreased (M = 7,120.33) from (M = 7,609.67). A two sample t-test indicated that this difference was significant, t(3.7730) = 0.0031, p = .005.Conclusions: Results confirmed that a multi-faceted education program can reduce inappropriate pathology test ordering, commonly over-ordered pathology test ordering, and pathology specimen error rates while maintaining positive patientoutcomes.