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      Providing clinicians with information on laboratory test costs leads to reduction in hospital expenditure

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          Abstract

          OBJECTIVES: We aimed to ascertain the efficacy of an intervention inwhich laboratory test costs were provided to clinicians as a pocketsizedbrochure, in reducing laboratory test costs over a 4-monthperiod. METHODS: This was a non-randomised intervention study in theInternal Medicine wards at Steve Biko Academic Hospital, Pretoria, in which the intervention was laboratory test costs provided toclinicians as a pocket-sized brochure. The intervention period wasthe winter months of May - August 2008 and the pre-interventionperiod was the same months of the preceding year. In the two4-month periods (2007 and 2008), the number of days in hospitaland the laboratory tests ordered were computed for each patientadmitted. For the intervention and control groups, pre- and postinterventioncost and days in hospital were estimated. RESULTS: The mean cost per patient admitted in the interventiongroup decreased from R2 864.09 to R2 097.47 - a 27% reduction.The mean cost per day in the intervention group as a whole alsodecreased, from R442.90 to R284.14 - a 36% reduction. CONCLUSION: Displaying the charges for diagnostic tests on thelaboratory request form may significantly reduce both the numberand cost of tests ordered, and by doing so bring about considerablein-hospital cost savings.

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          Non-evidence-based variables affecting physicians' test-ordering tendencies: a systematic review.

          The concept of evidence-based medicine (EBM) was introduced in 1992. Incorporation of EBM into physicians' practices, however, has been slow. Testordering tendencies are still based on variables that are not necessarily evidence-based. The literature was reviewed to identify the non-EBM variables that affect physicians' practices of test ordering. Studies of interest were limited to original research on the determinants of physicians' test-ordering tendencies. The search strategy included queries in MEDLINE (1992-2006), Web of Science (1993-2006), EMBASE (1992-2006), and PsycINFO (1992-2006); checking of reference lists; hand searching relevant journals; and personal communication with experts. Two independent reviewers abstracted information on the design, quality, and limitations of the study. Review articles, letters, and editorials were excluded from analysis. 104 original studies reporting on the variables affecting test ordering were identified. Of these, 53 studies assessing physician variables affecting test ordering were identified. Some of the recognisable physician factors included age, sex, degree of specialisation, geographic location and practice setting, individual belief systems, experience, knowledge, fear of malpractice litigation, physician regret, financial incentives, awareness of costs of tests ordered, and provision of written feedback by peers or employers. Despite considerable advances in our understanding of EBM and its application to patient care, several non-EBM physician variables influence physicians' test-ordering characteristics. Ongoing effort is needed to identify the modifiable non-EBM determinants of physicians' test ordering and to use appropriate tools and techniques to encourage evidence-based behaviours for test ordering.
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            Surgical vampires and rising health care expenditure: reducing the cost of daily phlebotomy.

            To determine whether simply being made continually aware of the hospital costs of daily phlebotomy would reduce the amount of phlebotomy ordered for nonintensive care unit surgical patients. Prospective observational study. Tertiary care hospital in an urban setting. All nonintensive care unit patients on 3 general surgical services. A weekly announcement to surgical house staff and attending physicians of the dollar amount charged to nonintensive care unit patients for laboratory services during the previous week. Dollars charged per patient per day for routine blood work. At baseline, the charges for daily phlebotomy were $147.73/patient/d. After 11 weeks of residents being made aware of the daily charges for phlebotomy, the charges dropped as low as $108.11/patient/d. This had a correlation coefficient of -0.76 and significance of P = .002. Over 11 weeks of intervention, the dollar amount saved was $54,967. Health care providers being made aware of the cost of phlebotomy can decrease the amount of these tests ordered and result in significant savings for the hospital.
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              Health Care Reform — Where Are We and Where Should We Be Going?

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                samj
                SAMJ: South African Medical Journal
                SAMJ, S. Afr. med. j.
                Health and Medical Publishing Group (Cape Town )
                2078-5135
                October 2011
                : 101
                : 10
                : 746-748
                Affiliations
                [1 ] Steve Biko Academic Hospital and University of Pretoria South Africa
                [2 ] University of Pretoria South Africa
                [3 ] University of Pretoria South Africa
                Article
                S0256-95742011001000029
                22272854
                31c7c3e3-ad31-4d5e-bba5-dbb455331a64

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO South Africa

                Self URI (journal page): http://www.scielo.org.za/scielo.php?script=sci_serial&pid=0256-9574&lng=en
                Categories
                Health Care Sciences & Services
                Health Policy & Services
                Medical Ethics
                Medicine, General & Internal
                Medicine, Legal
                Medicine, Research & Experimental

                Social law,General medicine,Medicine,Internal medicine,Health & Social care,Public health

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