Impact of sharing laboratory test costs and required blood volumes on resident test ordering
Bibliographic record
Abstract
Background and purpose: A significant proportion of inpatient laboratory testing is unwarranted and can lower quality of care, increase healthcare expenditures, and contribute to unnecessary investigations with their attendant comorbidities. This study investigates the relationship between the provision of information about costs and patient impact of laboratory testing, and resident ordering habits. Methods: Two independent four-week Internal Medicine resident blocks were studied. After two weeks, cost and blood volume information was distributed to residents during a 10-minute intervention. Pre- and post-intervention resident surveys measuring importance and influence of the intervention information were conducted. The daily number of blood collections and tests ordered, normalized to patient admission volumes, were analyzed by interrupted time-series analysis. Results: There was no significant effect of the intervention on resident test ordering. Despite this, 74% (N=34) and 63% (N=29) of pre-intervention responses predicted that cost and blood volume information respectively, would impact their ordering. All post-intervention responses (N=46) stated that these factors had influenced their ordering. Residents were unaware of the intervention information beforehand and demonstrated limited retention. Conclusions: This study design illustrates a disparity between observed resident test ordering habits and their belief that the intervention altered their ordering practices. Education on cost and blood volumes, by distribution of pamphlet, did not influence resident test ordering demonstrating that interventions to reduce non-specific test ordering should utilize an alternative educational approach. Keywords: Inappropriate testing, medical education, diagnostic stewardship, resident education
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.088 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".