TY - JOUR T1 - Implementing effective test utilization via team-based evaluation and revision of a family medicine laboratory test requisition JF - BMJ Open Quality JO - BMJ Open Qual DO - 10.1136/bmjoq-2020-001219 VL - 10 IS - 1 SP - e001219 AU - Zahraa Mohammed-Ali AU - Seema Bhandarkar AU - Shafqat Tahir AU - Curtis Handford AU - Drake Yip AU - Daniel Beriault AU - Lisa K Hicks Y1 - 2021/03/01 UR - http://bmjopenquality.bmj.com/content/10/1/e001219.abstract N2 - Revision of laboratory test requisitions is a simple utilisation strategy that can reduce unnecessary testing.1 2 The goal of this study was to improve test utilisation via a collaborative team-based evaluation and revision of a standardised lab requisition used by six large family medicine units.Revising the family requisition formA historical laboratory requisition used by the Family Medicine Department at Unity Health, St. Michael’s Hospital site, Unity Health Toronto, Toronto, Canada, was reviewed and modified by a steering committee comprised of family medicine clinicians (physicians and a nurse practitioner), lab medicine specialists and a quality improvement specialist. Decisions were made by consensus, and input was sought from the entire Department of Family Medicine via departmental rounds before changes were finalised. Laboratory tests were removed from the requisition if there was evidence in the literature of overuse (eg, Aspartate Aminotransferase (AST), folate, urea, Erythrocyte Sedimentation Rate (ESR),3 4 if they were outdated (eg, amylase, Creatine Kinase (CK)),3 or if there was consensus that they were infrequently needed in a family practice (eg, rheumatoid factor, direct bilirubin). The requisition was also revised to improve readability, and education was imbedded regarding some special tests such as urine toxicology screening and coagulation testing (changes in online supplemental table 1). Tests that were removed from the requisition remained orderable with longhand.Supplementary data[bmjoq-2020-001219supp001.pdf]Data analysesThe primary outcome was the monthly volume of targeted tests ordered by the family medicine clinic 6 months pre- and 6 months post-requisition changes (September … ER -