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The effect of a gold coin fine on C-reactive protein test ordering in a tertiary referral emergency department

Testing for C-reactive protein (CRP), an acute-phase reactant, is used in investigations for patients who present to emergency departments (EDs). It has been assessed for such roles as identifying bacteraemia in febrile patients,14 evaluating patients with an acute abdomen,5,6 and diagnosing patients with possible osteomyelitis or septic arthritis.7 However, such studies have not shown the CRP test to be useful for any of these indications, or indeed for most conditions for which patients present to EDs. Despite this paucity of evidence, CRP tests continue to be ordered as part of the work-up for patients presenting to EDs.

Nepean Hospital is a tertiary referral hospital that serves the western suburbs of Sydney in New South Wales, Australia. About 60 000 patients attend its ED each year. The ED has a 20% paediatric caseload and a 36% admission rate.

This study resulted from an audit of pathology test ordering in the Nepean Hospital ED. The aim of the audit was to determine what and how many tests were being ordered, the cost to the department and who was being billed for the tests. Also examined was…