Appropriate use of laboratory test requests in the emergency department: a multilevel intervention

Eur J Emerg Med. 2019 Jun;26(3):205-211. doi: 10.1097/MEJ.0000000000000518.


Objective: Laboratory test requests in the emergency department (ED) are increasing worldwide. We evaluated whether a multilevel intervention on the basis of the optimization of test profiles and educational meetings with physicians could reduce the number of tests ordered.

Patients and methods: In a single-center before and after study design, the 8-month intervention period was compared with the 8-month preintervention period. Laboratory test profiles were reduced from 6 to 2 and the number of tests in each profile was reduced by 50%. All physicians received education about the costs and appropriate use of the tests. Primary outcomes were the number of laboratory blood tests and their costs, with a focus on high-cost tests. Secondary outcomes were ED and laboratory performances (patients' waiting time, number of deaths in ED, re-entry, laboratory turn-around time, and add-on tests).

Results: Overall, 61 976 and 61 154 patients were evaluated, respectively, during the intervention and the preintervention period. Laboratory blood test requests were decreased by 207 637 (-36.3%) in the intervention period (P < 0.05), which corresponds to a reduction of 337.3 tests/100 patients. Costs were decreased by 608 079&OV0556; ( - 29.6%, P < 0.05), leading to a cost reduction of 981.2&OV0556;/100 patients. High-cost test requests decreased by 11 457 ( - 27.3%) and contributed toward the overall reduction in costs with 197 206&OV0556; ( - 30.5%). No significant differences were found in ED and laboratory performances between intervention and preintervention periods.

Conclusions: Optimization of test profiles and education on the costs and appropriate use of the tests significantly reduced laboratory test ordering and costs without affecting ED and laboratory performances.

Publication types

  • Comparative Study

MeSH terms

  • Clinical Laboratory Techniques / economics
  • Cost Savings
  • Diagnostic Tests, Routine / economics
  • Diagnostic Tests, Routine / statistics & numerical data*
  • Emergency Service, Hospital / organization & administration*
  • Female
  • Hospital Costs
  • Hospitals, University
  • Humans
  • Italy
  • Male
  • Outcome Assessment, Health Care*
  • Practice Patterns, Physicians' / economics*
  • Quality Improvement
  • Risk Assessment
  • Unnecessary Procedures / statistics & numerical data*