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.

## 背景
随着巴西统一卫生体系（Brazilian Unified Health System）确立的原则带来的医疗服务需求持续增长，当前公共卫生局势愈发复杂，涉及维持此类服务所需的资金与支持保障。有报告显示，诊断资源常被过度且不必要地使用，这对患者及医疗服务机构（尤其是医院）的预算造成了负面影响。
## 目的
本研究旨在评估圣保罗大学（Universidade de São Paulo, USP）里贝朗普雷图医学院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。
## 方法
本研究为横断面研究，对2012年7月至2013年7月期间内分泌科与心内科门诊的检验项目开展分析。
## 结果
12个月间的检验总数量较为接近，但心内科门诊的人均检验频次更高，达10.36，内分泌科门诊则为5.91。此外，对检验分项指标的分析显示两组结果相近：心内科的检验分项指标平均变更率为20.79%，内分泌科则为22.39%。
## 结论
明晰大型医院中医师开具实验室检验申请的行为模式，可促使管理者探索优化此类高复杂度医疗中心运营管理的方案，进而提升医疗服务效率、质量与教学水平。