The Danger of Underordering
Tests
Inadequate preoperative evaluation leads to the missing of potential
problems or to delays in the OR schedule for at least 15% of even healthy (ASA I)
patients.[24]
In addition, trying to reduce testing
without such a system of assessment in place may not be beneficial. Since 1979,
physicians at three university practices were found to decrease the ordering of unwarranted
tests almost 1.5 times as fast as they decreased the ordering of indicated tests
(19.6% and 12.9%, respectively).[269]
This would
be good if the benefit from decreasing unjustified tests outweighed the benefit of
ordering the truly useful ones. However, the possible benefit from a justified test
is probably more than 1.5 times the possible benefit from not ordering an unjustified
test, at least regarding preoperative tests. Therefore, the net changes that have
occurred in preoperative test selection since 1979 may not be beneficial. One is
forced to conclude that a better system for obtaining the warranted tests and for
eliminating the unwarranted tests may be a necessary supplement to education and
to standard endorsements for the reduction of costs and errors if selective application
of laboratory tests is to be beneficial.[269]
This
process calls for the use of information systems and an evaluative clinic. The need
for an information system and clinic to make the idea work is accentuated by data
on the errors made when selecting tests without the availability of an information
system.
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