Abstract
Objective
Overuse of diagnostic tests is of particular concern for pediatric academic medical
centers. Our objective was to measure variation in testing based on proportion of
hospitalization during the day versus night and the association between attending
in-house coverage on the teaching service and test utilization for hospitalized pediatric
patients.
Methods
Electronic health record data from 11,567 hospitalizations to a large, Northeastern,
academic pediatric hospital were collected between January 2007 and December 2010.
The patient-level dataset included orders for laboratory and imaging tests, information
about who placed the order, and the timing of the order. Using a cross-sectional effect
modification analysis, we estimated the difference in test utilization attributable
to attending in-house coverage.
Results
We found that admission to the teaching service was independently associated with
higher utilization of laboratory and imaging tests. However, the number of orders
was 0.76 lower (95% confidence interval:−1.31 to −0.21, P = .006) per 10% increase in the proportion in the share of the hospitalization that
occurred during daytime hours on the teaching services, which is attributable to direct
attending supervision.
Conclusions
Direct attending care of hospitalized pediatric patients at night was associated with
slightly lower diagnostic test utilization.
Keywords
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Article Info
Publication History
Published online: October 21, 2019
Accepted:
September 25,
2019
Received:
September 5,
2018
Footnotes
The authors have no conflicts of interest to disclose.
Identification
Copyright
Copyright © 2019 by Academic Pediatric Association
