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Standard admission order sets promote ordering of unnecessary investigations: a quasi-randomised evaluation in a simulated setting
  1. Benjamin Leis1,
  2. Andrew Frost2,
  3. Rhonda Bryce3,
  4. Kelly Coverett2
  1. 1 Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
  2. 2 Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
  3. 3 Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
  1. Correspondence to Dr Benjamin Leis, Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan S7N 0W8, Canada; btl127{at}mail.usask.ca

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Introduction

Standard admission order sets have become ubiquitous across hospitals to promote adherence to practice guidelines and increase ordering efficiency.1 2 This standardisation arose in part out of a need to minimise waste in healthcare, a phenomenon identified as a major barrier to reducing future healthcare costs.3 However, few studies have systematically evaluated whether these standardised orders can actually promote overordering of investigations. At our academic hospital’s coronary care unit (CCU), a single mandatory generic order set is used regardless of admitting diagnosis and includes optional check boxes for serum thyroid-stimulating hormone (TSH) and brain natriuretic peptide (BNP). We postulated that physicians order investigations differently on admission based on which investigations are included in the admission order set.

Methods

We quasi-randomised a convenience sample of participants in a double-blind fashion to receive either our standard CCU admission order set or a slightly modified version (see online supplementary file). The participants included internal medicine staff physicians, residents and clinical clerks (medical students, year 3 or 4) at our academic centre who were attending grand rounds. After their respective grand rounds, seated participants were provided with a case of a previously healthy 50-year-old man presenting with uncomplicated ST elevation myocardial infarction, now stable postpercutaneous revascularisation. Based on the clinical information provided, ordering TSH and BNP was not clinically indicated. Unaware of the differing versions, volunteer participants received a paper copy of one of the two versions of the admission order set. Researchers distributing the order sets were also not aware of which version of …

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