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Strategies to Change Physician Ordering Behavior

Laboratory is well positioned to identify test utilization issues throughout the testing cycle and address them. Test utilization should be defined as a strategy for reducing unnecessary testing and encouraging appropriate testing to improve the quality of care and provide decision support to assist clinicians in selecting correct tests from the ever-increasing test menu.

Lab professionals must become fully engaged with clinical practice in any test utilization process. They must become comfortable and confident interacting with clinical colleagues. They need to question test requests that seem out of place and suggest appropriate tests to answer clinical question being asked. Inappropriate test orders should be canceled after conferring with the ordering physician.

Lundberg reviewed 49 articles between 1966 and1998 and listed strategies that do and do not work to change physician ordering behavior (JAMA 1998;280:2020).

Strategies that DO NOT work by themselves

  • Physician consensus building
  • Test guideline dissemination
  • Traditional education
  • Utilization audits
  • Informing physicians of lab charges

Strategies that DO WORK

  • Administrative interventions
  • Environmental interventions
  • Combinations of these 2 with other strategies

Lundberg then laid out his principles for changing physician behavior:

  • Know the right thing to do
  • Confer with respected physician leaders
  • Implement changes administratively
  • Educate through writing and conferences
  • Weather the storm
  • Remain open to communication
  • Enjoy the success of more effective service

In the next blog specific examples of environmental interventions will be discussed.  

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