Title:Laboratory test requests from three university hospital emergency departments in Iran

Author:Maryam Bahreini, Soheil Rafiee, Azar Hadadi, Pooya Payandemehr and Fatemeh Rasooli

Abstract:Background: Laboratory requests can be justified and trimmed to what patients necessarily need. Reducing unnecessary laboratory requests can improve patient safety and both patient and provider satisfaction. 
Methods: In this study, the current status of laboratory requests was assessed in emergency departments of three multidisciplinary university hospitals based on ten most expensive and most requested laboratory tests and categorised by the ordering physicians and patients’ chief complaints in a 6-month period. These hospitals had annual visits to the emergency departments of between 20,000 – 72.000 patients.
Results: The most requested tests were as follows: complete blood count, biochemistry profile including sodium, potassium, urea, and creatinine. Moreover, the cumulating most expensive tests were coagulation profile, cardiac troponin, C-reactive protein, erythrocyte sedimentation rate, liver enzymes, alkaline phosphatase, and blood gases corresponding to the frequency of requests in the emergency department. Among the services, other than emergency medicine, requesting laboratory work in the emergency departments, internal medicine, neurology and surgery services had requested more laboratory tests comprising 44.0, 24.4, and 20.8 % of all specialties respectively. Moreover, the most frequent laboratory requests were from patients complaining of abdominal pain, chest pain, and penetrating or blunt traumatic injuries.
Conclusions: It should be considered to rationally request the most frequent laboratory tests as many of them can be canceled by physicians and do not change the diagnosis, treatment, prognosis, and disposition in the emergency department.
Key Words: diagnostic tests, routine, laboratories, emergency department.
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