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Study: 1 in 5 patient encounters involves discussion of ACP test-ordering principles

Low percentages of physicians engage in the discussion of test-ordering principles during teaching rounds, according to a findings published in JAMA Internal Medicine.

In light of the results, the researchers advocated for the standardization of discussion for testing of patients in order to improve patient care, education and the health care system.

"In 2012, the American Board of Internal Medicine launched its Choosing Wisely campaign to help physicians more thoughtfully consider diagnostic testing," Cason Pierce, MD, MA, Denver Health Medical Center, and colleagues wrote. "The American College of Physicians published five questions physicians should ask before ordering tests. Because educators are encouraged to teach these principles to trainees, we sought to quantify how frequently attending physicians lead their discussion."

Pierce and colleagues trained observers to shadow physicians and record their teaching rounds. Seventeen rounding episodes at Denver Health and the University of Colorado Anschutz were included in their final analysis, which consisted of 168 patient encounters, 17 rounding days and 16 unique attending physicians.

Results showed that 35 (20.8%) of patient encounters involved physician-led discussion of at least one test-ordering principle. The test-ordering principle of whether the test results would affect care was discussed most frequently (13.7%) and the test-ordering principle of short-term harm was discussed least frequently (2.4%).

Additionally, the researchers found that discussion did not differ between new patients and known patients (P = .09) and no correlation between discussion and bedside time. Test-ordering principle discussion was positively correlated with total teaching time (P < .001).

"In our view, discussion of these principles offers potential benefits, including improved test-ordering appropriateness and more patient-centered care," Pierce and colleagues wrote. "Because ward rounds continue to serve as a key educational forum for trainees, our observation that only one in five encounters involves attending physician-led discussion of these principles is discouraging." – by Chelsea Frajerman Pardes

Disclosures: The authors report no relevant financial disclosures.