Requests for coagulation studies have dropped by over a third with a concerted effort to encourage more appropriate ordering of the tests across Austin Health.
Austin’s clinical director of emergency medicine Dr Simon Judkins told the limbic the tests had become almost routine, especially in the emergency department. They were often ordered for patients with chest pain or as a pre-op work-up when just an INR would suffice.
“Coagulation studies had become a ‘just in case’ type of test. When we actually asked doctors what they needed, it might be that an INR and platelets was all that was required.”
Dr Judkins, who also chairs the Choosing Wisely committee at Austin Health, said an initial audit of ordering practice provided some early wins.
“We were able to identify who was ordering these tests more than others and feed that back to clinicians. It was quite a positive process – providing doctors with the opportunity to reflect on what they were doing.”
He said doctors might be trying to be efficient by ordering tests in a bundle but it was more often about convenience rather than answering clinical questions.
Over-ordering tests was at least wasteful and had inherent risks such as incidental findings which might lead to further unnecessary tests.