A randomized trial of a computer-based intervention to reduce utilization of redundant laboratory tests

PURPOSE: To determine the impact of giving physicians computerized reminder s about apparently redundant clinical laboratory tests. SUBJECTS AND METHODS: We performed a prospective randomized controlled tria l that included all inpatients at a large teaching hospital during a 15-wee k period. The intervention consisted of computerized reminders at the time a test was ordered that appeared to be redundant. Main outcome measures wer e the proportions of clinical laboratory orders that were canceled and the proportion of the tests that were actually performed. RESULTS: During the study period, there were 939 apparently redundant labor atory tests among the 77,609 study tests that were ordered among the interv ention (n = 5,700 patients) and control(n = 5,886 patients) groups. In the intervention group, 69% (300 of 437) of tests were canceled in response to reminders. Of 137 overrides, 41% appeared to be justified based on chart re view. In the control group, 51% of ordered redundant tests were performed, whereas in the intervention group only 27% of ordered redundant tests were performed (P < 0.001). However, the estimated annual savings in laboratory charges was only $35,000. This occurred because only 44% of redundant tests performed had computer orders, because only half the computer orders were screened for redundancy, and because almost one-third of the reminders were overridden. CONCLUSIONS: Reminders about orders for apparently redundant laboratory tes ts were effective when delivered. However, the overall effect was limited b ecause many tests were performed without corresponding computer orders, and many orders were not screened for redundancy. Am J Med. 1999;106: 144-150. (C) 1999 by Excerpta Medica, Inc.