This is an open access article under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/). Signa Vitae 2021 vol.17(6), 37-42 ©2021 The Author(s). Published by MRE Press. http://www.signavitae.com/ Submitted: 26 March, 2021 Accepted: 21 April, 2021 Published: 08 November, 2021 DOI:10.22514/sv.2021.091 ORIGINAL RESEARCH Pre- and post-training changes in the test-ordering behavior of the emergency physicians in the management of adults with acute gastroenteritis Sarper Yilmaz 1, * , Ozgur Karcioglu 2 , Ozgur Dikme 2 1 Department of Emergency Medicine, University of Health Sciences, Kartal Dr. Lütfi Kırdar City Hospital, 34862 Kartal, Istanbul, Turkey 2 Department of Emergency Medicine, University of Health Sciences, Istanbul Education and Research Hospital, 34098 Fatih, Istanbul, Turkey *Correspondence sarperyilmaz08@gmail.com (Sarper Yilmaz) Abstract Introduction: The aim of this study is to investigate the education-inflicted changes in the test-ordering behavior of the emergency physicians in the management of patients with a presumptive diagnosis of acute gastroenteritis (AGE). Methods: The study was designed as a single-center interventional study and was conducted in a large training hospital over a two-month period. In the first month of the study; physicians’ test ordering behavior in patients with acute AGE was analyzed (Group 1). After one-month period, physicians working in the hospital emergency department (ED) underwent a one-hour focused training on the management of patients with AGE. One month after the training, variations in test order habits were observed and recorded (Group 2). Before and after the training; demographic information, vital signs on admission, complaints, physical examination findings, associated conditions, and the work-up results were analyzed comparatively. Results: Following the education session, there was a decrease of 6% in the rate of tests ordered for the patients and an increase of 11% in the rate of pathological findings on the laboratory work up. The patients’ blood pressure, body temperature and heart rate were the factors without any effect on test-ordering behavior. In the present study, the ratio of patients ordered tests in the management of AGE in the ED was found to be lower and the rate of pathological findings was higher in the post-education period when compared to pre-education period. Conclusions: Future population-based well-designed studies will enlighten the possible effect of education on test-ordering in acute medicine. Keywords Emergency department; Acute gastroenteritis; Test ordering; Education; Cost- effectiveness 1. Introduction There is no universal definition of the specific clinical cri- teria that correlate with AGE. The 2016 American College of Gastroenterology (ACG) guidelines use a definition that emphasizes diarrhea in the diagnostic criteria, but also ac- knowledges that AGE can also be a “vomiting-predominant illness with little or no diarrhea” [1]. Although AGE is mostly a mild disease, certain clinical, demographic, or epidemiologic features can accompany complications or severe course of disease. People of all ages with acute diarrhea should be evaluated for dehydration, which increases the risk of life- threatening illness and death, especially among the young and older adults. Identification of the exact cause of diarrhea is not always necessary. Assessment of a stool specimen to determine the cause should be performed on patients at high risk of severe illness and for whom identification of a pathogen would be important for the patient or for public health reasons. In selected and suspect cases; stool tests, duodenal fluid, blood cultures or culture-independent diagnostic tests (CIDTs) are recommended. However, there are no clear patient groups predefined for orders of blood biochemistry and complete blood count [2]. AGE represents one of the five leading causes of death worldwide and is the second most important cause of death for children under the age of five (behind acute respiratory infections). Most cases of AGE are associated with contaminated food and water resources and around 2.4 billion people globally do not have access to basic sanitation [3]. Although diarrhea is so common and causes substantial problems, there is no common protocol developed for the diagnosis and examinations for AGE. Laboratory work up is an integral part of the diagnostic investigation performed on patients presenting to EDs. Laboratory test orders in the ED are increasing worldwide, in accord with referral to the hospitals [4]. The number of patients increases by an average