A quality management intervention to improve clinical laboratory use in acute myocardial infarction

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Abstract
Objective To assess the effect of a total quality management (TOM) approach on the appropriateness of clinical laboratory testing of patients with acute myocardial infarction. Design Retrospective, control‐group, quasi‐experimental study. Setting Two metropolitan teaching hospitals: one involved in the intervention (TOM experimental group); the other had no intervention (control group). Intervention A multidisciplinary team involved in the development of improvement strategies, including laboratory testing guidelines, education programs, data collection, monitoring and feedback. Outcome measures Total number of requested clinically indicated and non‐clinically indicated tests. Results The proportion of clinically indicated tests that were requested increased from 77.5% to 88.2% (P<0.01) and the number of non‐clinically indicated tests was reduced by 81.7% with the introduction of the TOM strategies (P<0.01). Conclusions The introduction of a TOM approach has improved the appropriateness of test ordering in acute myocardial infarction. The reduction in non‐clinically indicated tests could produce substantial savings in hospital pathology costs, and the increase in clinically indicated tests provides better patient care.