Managing demand for pathology tests: financial imperative or duty of care?

Abstract

workload year on year, usually without increases in budgets to match. With the global 'credit crunch', it becomes even more relevant that national health service (NHS) organizations deliver evidence-based practice, provide value for money and reduce waste.Why are there so many requests?The reasons for this ever-increasing workload are manifold. Certainly technology has had an impact, though it seems that the faster we turn the results around, the more quickly they are needed. It is not just the analytical technology that has changed. Information technology now has bidirectional links and electronic patient requesting/reporting and the speed of data transfer have increased exponentially. Despite this, it feels as though it is always a step behind where it needs to be and can be a double-edged sword. When it works, rapid result availability can give the impression that tests are easy to perform, with consequent effects on increased requesting. When it fails, previous results are unavailable, resulting in increased duplicate testing.Changes to medical training and proliferation of nonmedical advanced multiprofessional practice also have a direct impact on the way in which pathology requests are made, and by whom. There is more protocol and guidelinebased requesting, sometimes by people who have relatively little pathology training. This can lead to unnecessary requests for batteries of tests for rare conditions or repeat requests for tests at ridiculous frequencies.

Preanalytical quality improvement. In pursuit of harmony, on behalf of European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working group for Preanalytical Phase (WG-PRE)

“…Practical examples of implementing improvement strategies obtained by this group are being collected and classified according to a reliable scheme describe elsewhere [19,20]. In brief, these entail general and/or specific strategies guided by studies of variability and/or application of evidencebased medicine.…”

Inappropriate Requesting of Glycated Hemoglobin (Hb A1c) Is Widespread: Assessment of Prevalence, Impact of National Guidance, and Practice-to-Practice Variability

“…Although a range of factors, including training or specialist knowledge in some practices, variation in basic medical training, patient demographics, attitudes to risk and litigation, length of local knowledge, and so on, may account for some of the variability, the standardization of best practice across the healthcare community should remain a goal. Approaches to reducing this variability have been discussed elsewhere (2,3,13,21 ) and are beyond the scope of this article. Availability of data on previous test date and result has been suggested as a tool to limit overrequesting (3,13 ).…”

“…Approaches to reducing this variability have been discussed elsewhere (2,3,13,21 ) and are beyond the scope of this article. Availability of data on previous test date and result has been suggested as a tool to limit overrequesting (3,13 ). In our local health economy, secondary care has had access to general practitioners' results throughout the study period, but the converse was not always the case.…”

“…Similarly, patients may have tests sooner than guidance because of patient pressure, lack of awareness of the capability of the test itself, and so forth (13,21 ). Although some of these reasons may be justifiable, they can in no way account for the magnitude of nonconformity.…”

“…Unlocking the key to this variation and identifying the prevalence and impact of inappropriate requesting, both under-and overrequesting, would have major implications for reducing patient inconvenience and allow targeting of finite health service resources to areas of known patient benefit (13 ).…”