Improving house staff ordering of three common laboratory tests: Reductions in test ordering need not result in underutilization

Kurt Kroenke, James F. Hanley, John B. Copley, Joseph I. Matthews, Charles E. Davis, Charles J. Foulks, John L. Carpenter

Research output: Contribution to journalArticlepeer-review

32 Scopus citations


Most studies of modifying test ordering have focused on costs. Questions not addressed are whether programs to reduce testing lead to a higher proportion of clinically indicated tests and is underutilization an adverse outcome of such programs? To investigate this, we studied the house staff’s ordering of three common laboratory tests at baseline and after educational and administrative interventions. Over a 2-year period, 3, 603 urine cultures, sputum cultures, and admission urinalyses were reviewed. A lecture emphasizing the indications for these tests followed by chart audit and weekly feedback increased the proportion of clinically indicated tests. Subsequently, an administrative intervention requiring the intern to list the reason for ordering the test on the laboratory request form further improved test ordering. Underutilization, defined as a failure to order a potentially indicated test, was assessed during two representative periods’. The “underutilization rate” (omitted tests per 100 patients) was no worse during maximal intervention than it was 9 months after the last intervention (7.7 vs. 11.1, NS). No immediate adverse consequences resulted from tests not ordered. Our findings indicate that it may be possible to selectively reduce the ordering of unnecessary tests without sacrificing quality of care.

Original languageEnglish (US)
Pages (from-to)928-935
Number of pages8
JournalMedical Care
Issue number10
StatePublished - Oct 1987


  • Diagnosis
  • Diagnostic tests
  • Expenditures
  • Health
  • Health care
  • Laboratory
  • Medical education
  • Quality assurance
  • Routine
  • Urinary
  • Utilization review

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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