873 9 archive 2 disk0/00/00/08/73 2007-10-18 17:55:40 2007-10-29 18:54:32 2007-10-18 17:55:40 article show Al-Joudi, F.S. Wahab N.A. Nordin H. Universiti Sains Malaysia, Faculty of Medical Sciences, Dept. of Chemical Pathology Universiti Sains Malaysia, School of Medical Sciences, Dept. of Chemical Pathology Universiti Sains Malaysia, School of Medical Sciences, Dept. of Chemical Pathology pub R none Over-ordering, panel test, individual test, test duplication, chemical pathology The utilization of the chemical laboratory resources at the Hospital Sains Malaysia was evaluated. More than 100,000 test requests received and performed over a 12-month period, were analyzed retrospectively. The analysis conducted included the abnormal results obtained, the degree of duplication of tests, and the extent of test-panel ordering. It was found that a relatively moderate degree of over-ordering was evident. The findings suggested that the main reasons for over-ordering were the use of panel tests of ordering, in addition to a small, yet significant degree of duplication. Strategies for cutting down the test ordering have been reviewed and discussed. 2003-01 published Malaysian Journal of Medical Sciences 10 1 School of Medical Sciences, Kubang Kerian, Universiti Sains Malaysia 46-51 TRUE 1394195X http://www.medic.usm.my/publication/mjms/ 1- Griner, P.F. and Liptzin, B., Use of a laboratory in a teaching hospital: implications for patient care, education and hospital costs, Ann. Intern. Med., 1971;75: 157-63. 2- Valenstein, P., Leiken, A. and Lehmann, C., Tests ordering by multiple physicians increases unnecessary laboratory examinations, Arch Pathol Lab Med, 1988;112: 238-41 3- Martin, A.R., Wolf, M.A., Thibodeau, L.A., Dzan, V., and Braunwald, E., A trial of two strategies to modify the test ordering behavior of medical residents, N Engl J Med, 1980; 303: 1330-36. 4- Tydeman, J.T., Morroson, J.I., Cassidy, P.A. and Hardwick, D.F., Analyzing the factors contributing to rising laboratory costs, Arch Pathol Lab Med, 1983;107:7- 12. 5- Schifman R.B, Comprehensive and concurrent surveillance of test use, Am J Clin Pathol, 1989;92:539. 6- Ruttiman, S., Clemencon, D. and Dubach, U.C., Usefulness of complete blood counts as a case-finding test in medical outpatients, Ann Intern Med, 1993; 94:141-8. 7- Boland, B.J. and Silverstein, M.D., Review of systems, physical examination, and routine tests for case-finding in ambulatory patients, Am J Med Sci, 1995; 309: 194-200. 8- Silverstein, M.D. and Boland, B.J., Conceptual framework for evaluating laboratory tests: case-finding in laboratory patients, Clin Chem, 1994; 40: 1621-7. 9- Studnicki, J., Bradham, D.D., Marshburn, J., Foulis, P.R. and Straumford, J.V., A feedback system for reducing excessive laboratory tests, Arch Pathol Lab Med, 1993;117: 35-9. 10- Lyon, A.W., Greenway, D.C. and Hindmarsh, J.T., A strategy to promote rational clinical chemistry tests utilization, Am J Clin Pathol, 1995; 103: 718-724. 11- Hindmarsh, J.T and Lyon, A.W, Strategies to promote rational clinical chemistry test utilization, Clin Biochem, 1996; 29 (4): 291-99. 12- Bartlett, R.C, Making optimum use of the microbiology laboratory, JAMA, 1982; 247: 1868-71. 13- Lakshmanan, M.C, Hershey, C.O and Breslau, D, Hospital admissions caused by iatrogenic diseases, Arch Intern Med, 1986; 146: 1931-34). 14- Boland, B.J., Wollen, P.C. and Silverstein, M.D., Yield of laboratory tests for case-finding in the ambulatory general medical examination, Am J Med, 1996; 101:142-52. 15- Hubbell, F.A., Frye, E.B., Akin, B.V. and Rucker, L., Routine admission laboratory testing for general medical patients, Med Care, 1988; 26 (6): 619-30. 16- Kuwajima, M. and Ohnishi, Y., Usefulness of admission biochemical tests for general medical patients, Rinsho Byori, 1993; 41 (7): 759-65. 17- Schifman, R.B, Quality assurance goals in clinical pathology, Arch Pathol Lab Med, 1990; 114:1140-4. 18- Wachtel, T.J. and O’Sullivan, P., Practice guidelines to reduce testing in the hospital, J Gen Intern Med, 1990; 5: 335-41. 19- Silverstein, M.D., Decision making in clinical preventive medicine, Prim Care, 1989; 16: 9-30. 20- Baily, A., Biochemistry of well population, Lancet, 1974; 2: 1436-9. 21- Heath, H., Hodgson, S.F. and Kennedy, M.A., Primary hyperparathyroidism, incidence, morbidity and potential economic impact in a community, N Engl J Med, 1980; 302: 198-93. 22- Mafauzy, M., Mokhtar, N., Mohamad, W.B. and Musalmah, M., Diabetes mellitus and associated cardiovascular risk factors in north-east Malaysia, Asia Pac J Public Health, 1999; 11 (1): 16-9. 23- Larsson, A., Biom, S., Werroth, M.L., Hulten, G. and Tryding, N., Effects of an education program to change clinical laboratory testing habits in primary care, Scand J Prim Health Care, 1999; 17 (4): 238-43. 24- Everett, G.O., De Blois, C.S. and Chung, P., Effects of education, cost audits, and faculty chart review on the use of laboratory services, Arch Intern Med, 1983; 143: 942-944. 25- Tierney, W.M, Miller, M.E and McDonald, C.J, The effect on test ordering of informing physicians of the charges for outpatient diagnostic tests, N Engl J Med, 1990; 322 (21): 1499-504. 26- Bishof, R.O. and Nash, D.B., Cost-effectiveness and cost containment. A Physician’s primer, Prim Care, 1996; 23 (10): 115-26. 27- Larsson, A. and Tryding, N. Is it necessary to order aspartate aminotransferase with alanine aminotransferase in clinical practice? Clin Chem, 2001; 47 (6): 1133-4. 28- McGing, P.G and Kyne, F., Cutbacks in cardiac enzyme testing, Ann Clin Biochem, 1993; 30: 418-9. 29- Bradshaw, KE, Gardner, RM, Pryor, TA, Development of a computerized laboratory alerting system, Comput Biomed Res, 1989; 22: 575-87.