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Attitude Toward Inpatient Testing Frequency Varies By Provider Type

by | Oct 20, 2017 | Clinical Diagnostics Insider, Diagnostic Testing and Emerging Technologies, Testing Trends-dtet

While clinicians and several professional recognize that routine laboratory testing is overused in the inpatient setting, attitudes towards testing necessity differ by health care provider type, according to a research note published in the August issue of JAMA Internal Medicine. In the study, physicians (residents, fellows, and attending physicians) and nonphysician health care providers (nurse practitioners [NPs], physician assistants [PAs], and registered nurses [RNs]) with inpatient duties were electronically surveyed to assess attitudes towards inpatient laboratory testing. Among the 1,580 participants receiving an invitation to participate, 53 percent completed the survey (41 percent RNs, 197 attending physicians, 139 trainee physicians, and 154 APPs). Nearly three-quarters of respondents were female. "RNs are important care team members despite not placing orders. Little evidence describes their influence on the ordering process. We found that RNs generally favored more testing than other health care providers [but] the impact on test ordering is unclear." —Benjamin Roman, M.D. The researchers found that 60 percent of participants reported unnecessary laboratory testing on their unit, but only 37 percent reported requesting unnecessary laboratory testing themselves over the last six months. Differences by health care provider type were seen among those reporting requesting unnecessary testing themselves: trainees, 62 percent; […]

While clinicians and several professional recognize that routine laboratory testing is overused in the inpatient setting, attitudes towards testing necessity differ by health care provider type, according to a research note published in the August issue of JAMA Internal Medicine.

In the study, physicians (residents, fellows, and attending physicians) and nonphysician health care providers (nurse practitioners [NPs], physician assistants [PAs], and registered nurses [RNs]) with inpatient duties were electronically surveyed to assess attitudes towards inpatient laboratory testing. Among the 1,580 participants receiving an invitation to participate, 53 percent completed the survey (41 percent RNs, 197 attending physicians, 139 trainee physicians, and 154 APPs). Nearly three-quarters of respondents were female.

"RNs are important care team members despite not placing orders. Little evidence describes their influence on the ordering process. We found that RNs generally favored more testing than other health care providers [but] the impact on test ordering is unclear."

—Benjamin Roman, M.D.

The researchers found that 60 percent of participants reported unnecessary laboratory testing on their unit, but only 37 percent reported requesting unnecessary laboratory testing themselves over the last six months. Differences by health care provider type were seen among those reporting requesting unnecessary testing themselves: trainees, 62 percent; APPs, 59 percent; attendings, 43 percent; RNs, 14 percent.

"RNs are important care team members despite not placing orders," write the authors led by Benjamin Roman, M.D., from Memorial Sloan Kettering Cancer Center in New York. "Little evidence describes their influence on the ordering process. We found that RNs generally favored more testing than other health care providers [but] the impact on test ordering is unclear."

An interesting contradiction appeared in the results with nonattendings believing that attendings would be uncomfortable with less testing, but attendings overwhelmingly endorsing less testing. Misperceptions of attendings' beliefs may drive unnecessary testing, the authors say.

Takeaway: Improved communication among care team members could align clinicians' attitudes towards unnecessary inpatient laboratory testing.

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