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Appropriate use of laboratory test requests in the emergency department

a multilevel intervention

Nazerian, Peimana; Vanni, Simonea; Fanelli, Alessandrab; Fallai, Lindaa; Duranti, Cesareb; Ognibene, Agostinob; Rapi, Stefanob; Betti, Lauraa; Tomaiuolo, Matteoc; Calamai, Monicac; Grifoni, Stefanoa

European Journal of Emergency Medicine: June 2019 - Volume 26 - Issue 3 - p 205–211
doi: 10.1097/MEJ.0000000000000518
Original articles

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€ ( − 29.6%, P < 0.05), leading to a cost reduction of 981.2€/100 patients. High-cost test requests decreased by 11 457 ( − 27.3%) and contributed toward the overall reduction in costs with 197 206€ ( − 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.

Departments of aEmergency Medicine

bGeneral Laboratory

cGeneral Administration, Careggi University Hospital, Firenze, Italy

Received 16 June 2017 Accepted 22 September 2017

Correspondence to Peiman Nazerian, MD, Department of Emergency Medicine, Careggi University Hospital, Largo Brambilla 3, 50134 Firenze, Italy, Tel: +39 339 612 2448, +39 055 794 7322; fax: +39 055 794 7147; e-mail:

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