An interventional program for diagnostic testing in the emergency department

OBJECTIVE: To evaluate an intervention developed to improve test-ordering practice. SETTING: Public hospital emergency department with an annual census of 42 500. The study comprised a six-month pre-intervention stage (November 1998 to April 1999), which was compared with a similar post-intervention period (November 1999 to April 2000), and trends were examined over an 18-month post-intervention period (May 1999 to October 2000). INTERVENTION: The intervention comprised three integrated components: implementation of a protocol for test ordering; education program for medical staff; and audit/feedback process. MAIN OUTCOME MEASURE: Test utilisation (assessed as cost per patient). RESULTS: There was a 40% decrease in the ordering of investigations in the emergency department (95% CI, 29%-50%), with test utilisation falling from a mean of $39.32/patient to $23.72/patient. The decrease was similar for both laboratory and imaging tests and was sustained for the duration of the 18-month follow-up. CONCLUSIONS: Our intervention appears to have produced long term modification of test ordering in the emergency department of a public teaching hospital.