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Intervention to reduce C-reactive protein determination requests for acute infections at an emergency department
  1. I S Santos1,
  2. I M Benseñor1,2,
  3. J B A Machado3,
  4. L M G Fedeli3,
  5. P A Lotufo1,2
  1. 1University of São Paulo Medical School, Internal Medicine Department, São Paulo, Brazil
  2. 2University Hospital of the University of São Paulo, Internal Medicine Division, São Paulo, Brazil
  3. 3University Hospital of the University of São Paulo, Central Laboratory, São Paulo, Brazil
  1. Correspondence to Dr Itamar de Souza Santos, Hospital Universitario-USP, 2565 Professor Lineu Prestes Avenue 3o andar, Centro de Pesquisa Clínica, São Paulo, Brazil; itamarss{at}


Introduction C-reactive protein (CRP) levels rise during inflammatory processes and have been ordered for rheumatic disease follow-up since the 1950s. The number of tests ordered in the emergency setting has increased, but without evident improvement in medical care quality.

Objective To determine the pattern of CRP determinations in the emergency department (ED) of a university hospital in Sao Paulo, Brazil, and to evaluate the effect of an intervention with staff and students about the best use of the test in the ED.

Methods Data regarding CRP testing requests, related diagnoses and the number of monthly consultations in the hospital ED were analysed before and after the intervention. Because of an increase in CRP measurement requests from 2007 to 2009, the author started discussing the role of CRP determinations in the medical decision-making process in early 2010. Staff and faculty members openly discussed the pattern of requests in the hospital and related current medical literature. During 2010, the medical staff worked as multipliers to change the behaviour of new students and residents. The results of the first 4 months after the intervention were presented at another general meeting in July 2010.

Results From 2007 to 2009, there were 11 786 CRP measurement requests with a clear exponential trend. After the intervention, during the calendar year 2010, there was a 48% reduction in adjusted annual CRP requests. Pneumonia, fever and urinary tract infections were the most common reasons for CRP requests.

Discussion Inexpensive, well-directed, interactive educational interventions may affect professional behaviour and curb rates of laboratory tests.

  • Clinical assessment
  • education
  • effectiveness
  • emergency department
  • epidemiology
  • infection
  • prehospital care
  • primary care

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  • Competing interests The authors have no competing interests relating to the submitted work. Outside the present work, PAL has acted as a consultant for Astra-Zeneca and has received payment for manuscript preparation from Bristol Myers Squibb. IMB is responsible for grants (for the institution) from FAPESP and FINEP (government granting agencies), and PAL is responsible for grants (for the institution) from Eli-Lilly, Daichi and Novartis.

  • Ethics approval The study was registered and approved by the Internal Review Board of the Hospital Universitario da Universidade de Sao Paulo, Sao Paulo, Brazil.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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