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David W. Bates, MD, MSc
Brigham and Women's Hospital Boston, Mass

JAMA. 1996;275(10):758.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

In Reply.

—Dr Gambino has two main concerns about our study: that the low ordering appropriateness rate of 27% was found largely because blood samples were drawn at an inappropriate time, and that we did not address the issue of undermonitoring, which he considers more serious than over-monitoring. In fact, most levels were judged inappropriate because they were redundant (performed 1 or more days before they were indicated) and not simply drawn at the wrong time. This occurred because routine once-per-day determination of antiepileptic drug levels was performed regularly without pharmacological or clinical justification, accounting for the majority of the inappropriate determinations. Moreover, we did not consider the ordering of a level inappropriate if it was sampled at the wrong time, but incorrect sampling was an additional important problem: of the 27% of levels with an appropriate indication, 49% were sampled incorrectly. Dr Dorizzi and colleagues describe patterns of inappropriate . . . [Full Text PDF of this Article]

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