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

Objective: To assess the effect of a total quality management (TQM) 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 (TQM 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 TQM strategies (P<0.01). Conclusions: The introduction of a TQM 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.