League tables of biochemical laboratory costs. An attempt to modify requesting patterns.

"League tables", ordered by potential cost of biochemical laboratory tests requested, were distributed at four-week intervals to all medical specialists of a 500-bed tertiary care teaching hospital, Flinders Medical Centre, Adelaide, in an attempt to reduce the workload of the laboratory. This information feedback did not appear to have any effect on over-all laboratory utilisation or on any individual requesting pattern. However, much useful information on laboratory use was collated and summarised. It appears that more active intervention is required to eliminate unnecessary requesting of laboratory tests.

Effect of feedback to clinical staff of information on clinical biochemistry requesting patterns.

Attempting to reduce the number of unnecessary tests requested, we initiated a program providing continuous feedback to clinicians concerning their requesting patterns of clinical biochemistry laboratory tests. At four-week intervals each medical specialist received data showing the number and costs of tests requested by all members of his team, the number of patients who had tests, and various related information. Comparative summaries, in frequency-histogram format, of the number of specimens submitted and the costs involved allowed each medical specialist to rate his own performance against that of his peers. The program appeared to have no effect on laboratory use, although reliable information concerning workload patterns was accrued. The degree of education of medical students in clinical biochemistry did not appear to influence the use they made of the laboratory after qualification. The specimens per bed-day ratio is suggested as a useful parameter in the identification of inappropriate laboratory use and as a standard parameter for comparing laboratory use in different hospitals.