Algorithms for dosage and therapeutic monitoring of theophylline

What proportion of common diagnostic tests appear redundant?

PURPOSE

To identify ancillary tests for which there are criteria defining the earliest interval at which a repeat test might be indicated, to determine how often each test is repeated earlier than these intervals and, if repeated, provides useful information.

SUBJECTS AND METHODS

We performed a retrospective cohort study of 6,007 adults discharged from a large teaching hospital during a 3-month period in 1991. We measured the proportion of commonly performed diagnostic tests that were redundant, and their associated charges.

RESULTS

Of the 6,007 patients discharged, 5,289 (88%) had at least one of 12 target tests performed. Overall, 78,798 of the target tests were performed during the study period, of which 22,237 (28%) were repeated earlier than test-specific predefined intervals. This percentage varied substantially by test (range, 2% to 62%). To assess how many early repeats were justified, we performed chart reviews in a random sample stratified by test. For two tests, nearly all the initial results in the sample were abnormal, and all repeats were considered justified. Of early repeats following a normal initial result for the remaining 10 tests, chart review found no clinical indication for 92%, and a weighted mean of 40% appeared redundant. Overall, 8.6% of these 10 tests appeared redundant; if these were not performed, the annual charge reductions would be $930,000 at our hospital, although the impact on costs would be much smaller.

CONCLUSIONS

For some tests, an important proportion are repeated too early to provide useful clinical information. Most such tests might be eliminated using computerized reminder systems.

The design of an algorithm for pharmacists to evaluate ADRs in the elderly

An algorithm has been developed to help pharmacists who monitor patients being admitted to hospital to evaluate identified adverse drug reactions (ADRs). The design features six operational axes, comprising four subdivisions, with a unique score assigned to each. The final total of the sum of the individual scores for the six axes provides a measure of the probability that a suspicious event is drug-related.