Does feedback on cost or radiation dose for common diagnostic tests modify demand in a busy district general hospital? University of Nottingham

Rising demand for diagnostic tests is placing a strain on NHS resources. The number of CT scans completed at Royal Derby Hospital, for example, more than doubled between 2005 and 2014, reaching a total of over 45,000. Reducing the number of diagnostic tests that are completed without being clinically necessary would generate substantial cost savings. There is also an opportunity for clinicians to improve patient outcomes by avoiding unnecessary exposure to radiation in CT scans.

In an earlier study, the project team found that showing the cost of a simple blood test on the results form sent to clinicians led to a 32% drop in demand for the test. The team will build on this insight by trialling two interventions during a year-long study at Royal Derby Hospital. The interventions involve:

• adding the cost of commonly used blood tests - full blood count, urea and electrolytes, and liver function tests - to electronic and paper results
• adding information about radiation exposure and the associated increase in lifetime cancer risk to the results of chest, abdomen and pelvis CT scans.

The team will compare weekly demand for each blood test and CT scan with data from a control hospital, and track changes in clinicians’ knowledge of the risks of radiation exposure from CT scans. They will estimate the cost savings linked to each intervention, as well as the cost savings and health benefits that could be achieved if the interventions were rolled out nationally.

More information about the project can be found on its website.

Contact details

If any NHS institutions are interested in adopting or modifying this approach, the project team would be delighted to provide technical advice.

For more information, contact Darshan Patel, Behavioural Insights Research Programme manager at the Health Foundation, or Andrew Fogarty, Clinical Associate Professor in Clinical Epidemiology at the University of Nottingham.