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A study of ‘Rational Use of Investigations’ in a tertiary hospital

Introduction: A cross-sectional study for the prevalence and features associated with Rational Use of Investigations in a tertiary hospital of North India. A scope is always there to further enhance evidence based teaching and practice in healthcare. Medical students should develop at some point of time of their studies or early in their career, a set of preferred investigation (P-investigation) which they could use rationally and regularly. Somehow, this choice of investigations is often made on irrational background e.g. by copying pedagogically the prescribing behaviour of their teachers or peers without considering alternatives or knowledge gained by them in choosing the best, efficacious, economical and productive set of investigations. Objective: The objective of the study is to estimate the prevalence of rational use of investigations and its associated factors; to give practical advice on how to assist patients with reference to investigations; to enable the faculty to produce case specific P-investigations for their ready-reference.

Method: This study was conducted at the In-patient Department (IPD) of Jawaharlal Nehru Medical College & Hospital (JNMCH), Aligarh, India. In a period of 3 months, 90 patients were selected by random sampling with proportionate number from surgery and medicine wards. The prescribed investigations were analysed and compared by standard algorithm, made after group discussion with experts of the diagnosed case, in relation to investigations sought from the patients. Finally, a list of P-investigations was noted with proper reasons. Result: In our study, we observed 42 different types of clinical and laboratory investigations out of 2653 investigations ordered by physicians before any intervention. These investigations were done in 90 patients. Among those, 70.1% were not considered to have contributed towards management of patients (mean avoidable 3.07% tests/patient/day). 20% of the patients were advised thrice or more routine blood test. Senior residents (SRs) ordered more laboratory examinations, but the percentage of avoidable tests requested by junior residents (JRs) was higher.

Conclusion: Patient of geriatric age groups, and those who are hospitalised for many days for reasons including case difficulty to establish a diagnosis were the factors independently associated with overuse of laboratory tests. We found that there is no set guideline for laboratory investigations, physicians themselves decide to order investigations which may be rational or irrational. We must have logic based flow chart or algorithm in all investigations for diagnosis as a part of good laboratory or good clinical practices


Yasir Alvi, SZ Rahman, MS Zaheer

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