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Stephen B. Erban, MD; Judith L. Kinman, MA; J. Sanford Schwartz, MD

JAMA. 1989;262(17):2428-2432.

Abstract
The prothrombin time (PT) and activated partial thromboplastin time (APTT) tests are often routinely ordered for hospitalized patients. Ordering patterns and clinical indications for the PT and APTT tests on the medical service at a teaching hospital were studied. Eighty-one percent of all patients admitted to the medical service had a PT and APTT test ordered. When compared with a modified version of guidelines for the use of the PT and APTT tests recently developed by the Medical Necessity Project of the Blue Cross and Blue Shield Associations of America and endorsed by the American College of Physicians, at least 70% of these tests were not clinically indicated. Many of the unindicated tests were ordered prior to invasive procedures or, apparently, out of habit. These inappropriate PT and APTT tests cost at least $60 948 per year for the medical service. Based on these findings, we suggest methods of reducing the inappropriate use of the PT and APTT tests.

(JAMA. 1989;262:2428-2432)

Author Affiliations
From the Section of General Internal Medicine, Department of Medicine (Drs Erban and Schwartz), Clinical Epidemiology Unit (Ms Kinman and Dr Schwartz), and Leonard Davis Institute of Health Economics (Dr Schwartz), University of Pennsylvania, Philadelphia. Dr Erban is now with the Division of General Medicine and Primary Care, University of Massachusetts Medical Center, Worcester.

Footnotes
Reprint requests to Division of General Medicine and Primary Care, S7-715, University of Massachusetts Medical Center, 55 Lake Ave N, Worcester, MA 01655 (Dr Erban).

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