Rational, cost effective use of investigations

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7357.222/a (Published 27 July 2002) Cite this as: BMJ 2002;325:222

Rising workload and costs in diagnostic departments must be contained

  1. Sudha Bulusu (sudha.bulusu@newhamhealth.nhs.uk), consultant chemical pathologist
  1. Newham General Hospital, London E13 8RU
  2. Department of Rheumatology, Johannesburg Hospital, University of the Witwatersrand, Parktown 2193, Johannesburg, South Africa
  3. Aotearoa Health, RD1 Lyttelton, New Zealand

    EDITOR—Winkens and Dinant have highlighted some issues regarding the rising workload in pathology.1 In 1985 the workload in most diagnostic departments in the United Kingdom was reported to have been rising 10% a year whereas the number of inpatients and outpatients increased by less than 2% a year2; it is roughly similar now. A review of laboratory audits showed that the number of inappropriate tests requested by clinicians varies from 5% to 95%.3

    The common perception among physicians is that these tests are cheap. Their unit cost may be low, but they have a high cumulative cost.3 The annual bill for operating laboratory tests is greater than the annual cost of operating computed tomographic scanners.3

    Several methods to modify clinicians' use of diagnostic tests have been reported. The most potent interventions are methods that facilitate the preferred behaviour through blocking inappropriate requests or defaulting to the intended practice.4 In a study in the United States several characteristics were associated with a low level of laboratory use: being a leader, being part of a service group whose leader was a low user, clinical experience, being board certified, and being a graduate from “established” medical schools in the north east of America, Chicago, or California.5

    The two most important reasons for the rising workload and costs …

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