Duplicated laboratory tests: a hospital audit.

Rising healthcare costs are unlikely to be sustainable in the current healthcare environment. Reducing costs is a major effort of governments and policymakers (1). One component of these costs is the wide range and overwhelming number of diagnostic tests (2). Laboratory testing of hospitalized patients can be redundant when multiple providers order the same or similar tests for the same patient , contributing needlessly to the total healthcare costs (3–5). We evaluated the frequency of duplicate ordering of 6 in-house laboratory tests (Table 1) in hospitalized patients over a 12-month period and analyzed the costs associated with this practice. Research questions for this study included the following: (a) In this sample of hospitalized patients, what was the prevalence of duplication of the selected laboratory tests over twelve months, and (b) what were the costs associated with duplication of these laboratory tests? A retrospective descriptive design was used to evaluate the prevalence that selected tests were duplicated. We chose these 6 tests because a medical need to have 2 results for these tests during a single hospitalization was unlikely. This study was carried out in a large tertiary care organization in central Florida and used a sample of all patients admitted to the hospital who were older than 18 years and had an order for any of these tests between January 6, 2010 and December 31, 2010. Patients were excluded if they were discharged less than 24 h after admission or if their medical record was incomplete. Appropriate Institutional Review Board approval was obtained. An unnecessary repeated test was identified if it was performed more than once during the same hospitalization and if a final result was present in the electronic medical record before the second test was ordered. We used proportions as descriptive statistics to summarize the ordering and duplication of these selected tests. The annual cost for unnecessary duplication was estimated from the actual 2012 charge for each test paid to the vendor by the hospital to run the test. The cost did not include the charge to the patient or secondary payer and did not reflect reimbursement. The formula used for calculating total costs for 1 year was: Annual costs ϭ (Unit cost for test) ϫ (Number of duplicated tests). For the 6 tests examined, 53 351 tests were ordered, 10 375 of which were cancelled. Of the remaining 42 976 tests that were conducted , 4.6%– 8.7% …