Effectiveness of minimum retesting intervals in managing repetitive laboratory testing: experience from a Croatian university hospital

Abstract

Introduction: Inappropriate laboratory retesting can be addressed by implementing minimum retesting intervals (MRI). The aim of our study was to assess the effectiveness of the implemented MRI protocol for inpatients. Materials and methods: Minimum retesting intervals were applied for 53 laboratory tests. The overall reduction of test requests, reduction in charges and reagent cost savings, frequency of MRI alert appearance as well as the rate of MRI acceptance and ignorance were calculated for a one-year period. Reasons for violating the MRI rule, hospital departments that contributed mostly to MRI rule violation, and the frequency of MRI violations between routine and emergency laboratory were evaluated. Results: During the one-year period, 106,780 requests violated the MRI rule, which corresponds to 14.8% of all requests received. 13,843 requests were cancelled, yielding a 1.9% reduction of requested tests. High-volume tests, namely complete blood count, C-reactive protein, alanine aminotransferase, gamma-glutamyltransferase and total bilirubin, accounted for 65% of all generated alerts and had the highest alert ignorance (>85%). The highest cancellation rate was observed for tumor markers and autoimmunity tests, for most being at least 50%. Annual charge reduction was 62,641 EUR while reagent cost savings were 11,408 EUR. Tests performed in the emergency laboratory had a higher alert appearance than the same routine tests. The most common reason for MRI violation was clinical justification based on the patient’s condition. Most frequently ignored MRI alerts were in the intensive care unit. Conclusion: MRI implementation showed limited effectiveness in reducing testing repetition and achieving financial savings, yet provided the basis for future improvements.

Utility of procalcitonin in a medical intensive care unit in Croatia

“…The laboratory set turnaround time for test results was 60 min. According to available guidelines, minimum PCT retesting interval was set within the hospital laboratory order entry system at 24 h [25].…”

Laboratory Demand Management Strategies—An Overview

“…In the observational period of six months, 22% of the orders generated an alert and 77% of these tests were cancelled. Lapić et al [ 29 ] implemented an MRI for inpatients at a university hospital for 53 tests. The pop-up alert gave information about the inappropriateness, referred to the date as well as the status of the previous test request and included the possibility to override the warning.…”

“…Only a minority of surveyed clinicians stated that cost information frequently influenced their decisions. In general, cost control is endorsed by clinicians, but reductions in expenditure may be also achieved by implementing DM strategies, which combat overutilization [ 14 , 16 , 17 , 19 , 21 , 26 , 28 , 29 , 30 , 31 ].…”

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“…31 A study performed within a laboratory of a university hospital in Croatia showed that standardizing minimum intervals for performing tests could lead to a significant reduction (approximately 50%) in TM test orders, and consequently to a reduction in overall costs. 32 Similarly, Torre et al (2015) indicated that the number of adequately requested TMs increased from 31 to 78% once their utilization protocol was standardized. 33 Educational programs directed at primary care physicians could lead to a reduction of up to 51% in performed tests (TMs or not), saving approximately US$ 60 000 per year.…”