In recent years many initiatives have been introduced in clinical practice to reduce unnecessary use of care, including unnecessary diagnostics with the aim of controlling the increasing costs of healthcare and improving patient safety [1]. Although most initiatives demonstrate short term success only a few studies have investigated the long term sustainability of their interventions [2]. In 2009 we initiated a project at the Internal Medicine department of the VU University Medical Center in Amsterdam (VUmc), aiming to reduce the costs of unnecessary diagnostic tests.
