Chemistry test ordering patterns after elimination of predefined multitestchemistry panels in a children's hospital

Predefined multitest chemistry panels (PMCPs) have constituted a large prop ortion of laboratory tests and patient charges, even in pediatric settings, despite the absence of documented clinical utility for PMCPs and the gener al availability of random access analyzers that do not require predefined t est combinations. We eliminated PMCPs in our tertiary children's hospital b ut placed no other restrictions on ordering, and observed a 32.7% reduction in the number of automated chemistry tests ordered. All 23 tests in the pr evious PMCPs showed a decline in utilization, >50% for 8 of the tests and 2 0-50% for 13 others, and this change was sustained throughout an 8-month fo llow-up period. The total number of orders for one or more tests increased by 8.2%, but the variety of combinations that were ordered increased by 280 %. The most substantial changes included a decrease in the number of orders for combinations of >15 tests, and increases in the number of orders for s ingle tests and combinations of 2 to 5 tests. Orders for combinations ident ical to all of the former PMCPs declined, with the exception of the 4-test electrolyte panel. There was a marked decline in orders for a 7-test panel identical to the recently defined HCFA-AMA Basic Metabolic Panel, and order s for combinations identical to the HCFA-AMA Liver Function and Extended Me tabolic panels were vanishingly rare and nonexistent, respectively. The cal culated reduction in patient charges was much greater than actual cost savi ngs, but the reduction in total tests and increase in the variety of test c ombinations suggest that significant savings can be realized if clinicians are encouraged to order only the tests or combinations they need without im posing procedural, financial, and regulatory burdens.