Email updates

Keep up to date with the latest news and content from BMC Health Services Research and BioMed Central.

Open Access Research article

Using pathology-specific laboratory profiles in Clinical Pathology to reduce inappropriate test requesting: two completed audit cycles

Roberto Baricchi1, Michele Zini2, Maria Grazia Nibali3, Walter Vezzosi3, Vincenzo Insegnante1, Clotilde Manfuso1, Alessandra Polese1, Valmer Costoli1, Antonio Spelti1, Debora Formisano4, Danilo Orlandini6*, Fausto Nicolini5 and Antonio Poli5

Author Affiliations

1 Clinical Pathology Department, Clinical Pathology and Transfusion Laboratory of Castelnovo nè Monti, Arcispedale Santa Maria Nuova Hospital (IRCCS), Reggio Emilia, Italy

2 Surgical Department, Endocrinology, Arcispedale Santa Maria Nuova Hospital (IRCCS), Reggio Emilia, Italy

3 Castelnovo né Monti Primary Care Department, Castelnovo né Monti Healthcare District, Reggio Emilia, Castelnovo nè Monti, Italy

4 Statistics and Clinical Epidemiology Department, Statistical Unit, Arcispedale Santa Maria Nuova Hospital (IRCCS), Reggio Emilia, Italy

5 Hospitals Healthcare Management, Reggio Emilia Health Authority, Reggio Emilia, Italy

6 Education and Clinical Innovation Department, Healthcare Library - Clinical Governance Documentation Centre of the Healthcare Trusts of the Province of Reggio Emilia, Arcispedale Santa Maria Nuova Hospital (IRCCS), Reggio Emilia, Italy

For all author emails, please log on.

BMC Health Services Research 2012, 12:187  doi:10.1186/1472-6963-12-187

Published: 3 July 2012

Abstract

Background

Systematic reviews have shown that, although well prepared, the Consensus Guidelines have failed to change clinical practice. In the healthcare district of Castelnovo né Monti (Reggio Emilia, Italy), it became necessary for the GPs and Clinical Pathologists to work together to jointly define laboratory profiles.

Methods

Observational study with two cycles of retrospective audit on test request forms, in a primary care setting. Objectives of the study were to develop pathology-specific laboratory profiles and to increase the number of provisional diagnoses on laboratory test request forms. A Multiprofessional Multidisciplinary Inter-hospital Work Team developed pathology-specific laboratory profiles for more effective test requesting. After 8 training sessions that used a combined strategy with multifaceted interventions, the 23 General Practitioners (GPs) in the trial district (Castelnovo nè Monti) tested the profiles; the 21 GPs in the Puianello district were the control group; all GPs in both districts participated in the trial. All laboratory tests for both healthcare districts are performed at the Laboratory located in the trial district. A baseline and a 1-year audit were performed in both districts on the GPs’ request forms.

Results

Seven pathology-specific laboratory profiles for outpatients were developed. In the year after the first audit cycle: 1) the number of tests requested in the trial district was distinctly lower than that in the previous year, with a decrease of about 5% (p < 0.001); 2) the provisional diagnosis on the request forms was 52.8% in the trial district and 42% in the control district (P < 0.001); 3) the decrease of the number of tests on each request form was much more marked in the trial district (8.73 vs. 10.77; p < 0.001).

Conclusions

The first audit cycle showed a significant decrease in the number of tests ordered only in the trial district. The combined strategy used in this study improved the prescriptive compliance of most of the GPs involved. The presence of the clinical pathologist is seen as an added value.