Assessment of request of laboratory tests in a university hospital: consequences for Clinical and Management

Abstract Background The increasing demand of medical care according to the principles established by the Brazilian Unified Health System made the current situation of public health gain complexity involving funding and support to maintain these services. There are reports of excessive use of diagnostic resources often unnecessary, with consequences for patients and for the budget of health services, especially hospitals. Objective It was to evaluate the qualitative and quantitative results of laboratory tests ordered in the outpatient clinics of Cardiology and Endocrinology of the Hospital of the Ribeirão Preto Medical School-USP. Method A cross-sectional study was carried out. An analysis of the exams was performed in outpatient clinics in the endocrinology and cardiology between July/2012 and July/2013. Results The number of tests was similar over the 12 months, and the examination/patient relationship was higher in the cardiology clinic with 10.36 versus 5.91 observed in endocrinology clinic. Besides that, it was observed the sub-elements of the tests, which demonstrated similar results: in Cardiology average rate of change elements was 20.79%, whereas in endocrinology, the average was 22.39%. Conclusion Understanding the behavior of physicians in requesting laboratory examinations in a large hospital can stimulate leaders and managers to seek proposals to improve the management of these large centers of high complexity of care. Thus, they can seek efficiency, quality of care and teaching.

摘要 背景：按照巴西统一医疗系统（Brazilian Unified Health System）确立的准则，医疗服务需求持续攀升，当前公共卫生局势日趋复杂，涉及维持相关医疗服务所需的资金与保障支持。有报告指出，诊断资源常被过度且无必要地使用，这对患者及医疗服务机构（尤其是医院）的预算均产生了负面影响。
研究目的：本研究旨在评估里贝朗普雷图医学院-圣保罗大学（Ribeirão Preto Medical School-USP）附属医院心内科与内分泌科门诊开具的实验室检验的定性与定量结果。
研究方法：本研究为横断面研究，分析了2012年7月至2013年7月期间该院心内科与内分泌科门诊的检验项目数据。
研究结果：12个月内的检验总数量较为接近，但心内科门诊的人均检验量更高，达10.36项，内分泌科门诊则为5.91项。此外，对检验子项目的分析结果也较为相似：心内科的检验子项目平均变更率为20.79%，内分泌科的平均变更率为22.39%。
研究结论：明确大型医院中医师开具实验室检验的行为模式，可助力管理者与决策者制定优化方案，以改善这类高复杂度医疗中心的运营管理，进而提升医疗服务效率、诊疗质量与教学水平。