A quality management intervention to improve clinical laboratory use in acute myocardial infarction

Med J Aust. 1999 Jan 4;170(1):11-4.


Objective: To assess the effect of a total quality management (TQM) approach on the appropriateness of clinical laboratory testing of patients with acute myocardial infarction.

Design: Retrospective, control-group, quasi-experimental study.

Setting: Two metropolitan teaching hospitals: one involved in the intervention (TQM experimental group); the other had no intervention (control group).

Intervention: A multidisciplinary team involved in the development of improvement strategies, including laboratory testing guidelines, education programs, data collection, monitoring and feedback.

Outcome measures: Total number of requested clinically indicated and non-clinically indicated tests.

Results: The proportion of clinically indicated tests that were requested increased from 77.5% to 88.2% (P < 0.01) and the number of non-clinically indicated tests was reduced by 81.7% with the introduction of the TQM strategies (P < 0.01).

Conclusions: The introduction of a TQM approach has improved the appropriateness of test ordering in acute myocardial infarction. The reduction in non-clinically indicated tests could produce substantial savings in hospital pathology costs, and the increase in clinically indicated tests provides better patient care.

Publication types

  • Clinical Trial
  • Controlled Clinical Trial
  • Multicenter Study

MeSH terms

  • Aged
  • Clinical Laboratory Techniques / standards
  • Clinical Laboratory Techniques / statistics & numerical data*
  • Creatine Kinase / blood*
  • Female
  • Health Services Misuse / statistics & numerical data*
  • Hospitals, Teaching
  • Humans
  • Isoenzymes
  • Laboratories, Hospital / standards
  • Laboratories, Hospital / statistics & numerical data*
  • Male
  • Middle Aged
  • Myocardial Infarction / blood
  • Myocardial Infarction / diagnosis*
  • Myocardial Infarction / enzymology*
  • New South Wales
  • Outcome and Process Assessment, Health Care
  • Retrospective Studies
  • Total Quality Management / methods*


  • Isoenzymes
  • Creatine Kinase