Open AccessPerception of usefulness of laboratory tests ordering by internal medicine residents in ambulatory setting: A single-center prospective cohort study
Author(s) -
Dimitria Doi,
Rômulo Ribeiro do Vale,
Juliana S. C. Monteiro,
Glauco Cabral Marinho Plens,
Mário Ferreira,
Luiz Augusto Marcondes Fonseca,
Sandro Félix Perazzio,
Bruno Adler Maccagnan Pinheiro Besen,
A. Lichtenstein,
Leandro Utino Taniguchi,
Nairo Massakazu Sumita,
Aline Pivetta Corá,
Adriana Pasmanik Eisencraft,
Alberto José da Silva Duarte
Publication year - 2021
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0250769
Subject(s) - medical diagnosis , medicine , ambulatory , test (biology) , cohort , family medicine , health care , medline , ambulatory care , medical laboratory , surgery , nursing , pathology , paleontology , political science , law , economics , biology , economic growth
The demand for high value health care uncovered a steady trend in laboratory tests ordering and inappropriate testing practices. Residents’ training in laboratory ordering practice provides an opportunity for quality improvement. We collected information on demographics, the main reason for the appointment, preexisting medical conditions and presence of co-morbidities from first-visit patients to the internal medicine outpatient service of our university general hospital. We also collected information on all laboratory tests ordered by the attending medical residents. At a follow-up visit, we recorded residents’ subjective perception on the usefulness of each ordered laboratory test for the purposes of diagnosis, prognosis, treatment or screening. We observed that 17.3% of all ordered tests had no perceived utility by the attending resident. Tests were usually ordered to exclude differential diagnoses (26.7%) and to help prognosis estimation (19.1%). Age and co-morbidity influenced the chosen category to legitimate usefulness of tests ordering. This study suggests that clinical objectives (diagnosis, prognosis, treatment or prevention) as well as personalization to age and previous health conditions should be considered before test ordering to allow a more appropriate laboratory tests ordering, but further studies are necessary to examine this framework beyond this medical training scenario.