The laboratory test utilization management toolbox

Abstract

Efficiently managing laboratory test utilization requires both ensuring adequate utilization of needed tests in some patients and discouraging superfluous tests in other patients. After the difficult clinical decision is made to define the patients that do and do not need a test, a wealth of interventions are available to the clinician and laboratorian to help guide appropriate utilization. These interventions are collectively referred to here as the utilization management toolbox. Experience has shown that some tools in the toolbox are weak and other are strong, and that tools are most effective when many are used simultaneously. While the outcomes of utilization management studies are not always as concrete as may be desired, what data is available in the literature indicate that strong utilization management interventions are safe and effective measures to improve patient health and reduce waste in an era of increasing financial pressure.

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)

“…By effective evidence-based management of preanalytical phase, the laboratory can reduce the error rate and improve care for patient as well as clinical outcome [84]. For example, an evidence based approach to test requesting means that test requesting patterns are assessed for their appropriateness for each particular patient population and patient condition, by both reducing the rate of unnecessary test requests and ensuring that the right test is requested for the right patient (i.e., adequate utilization of tests which are necessary/useful in a specific patient population) [85]. To properly manage the test demand, a laboratory should, as already discussed in depth above (under section: 'Unnecessary laboratory tests -a matter of concern?…”

Removing Cerebrospinal Fluid Antibody Orders from the Test Menu Results in a Dramatic Decrease in Order Volume

“…However, it was difficult to ascertain the impact of our email memo, i.e., what benefit would we have seen if we had sent the memo out with a recommendation, but did not remove the orders from the test menu? Other studies suggest that the impact of education alone degrades over time (24), but educational effort is certainly warranted.…”

Laboratory utilization in the emergency department – are the requested tests patient-oriented?

“…Increased workload and test diversity, as well as the widespread use of laboratory tests in the management of emergency patients, all contribute to a significant rise in laboratory expenses. (4) The roots of inappropriate test ordering behaviour derive from historical practice. It has long been accepted that the laboratory serves as a user-friendly service providing physicians with all information requested.…”

“…Weighing all the points mentioned, the elimination of obsolete tests from the test menu, the setting-up of serum panels according to relevant guidelines and protocols, privilege ordering, computer-based limitation of test availability and the continuous education of clinicians can significantly improve laboratory cost-effectiveness. (4, 5, 9, 10) Some authors (4) claim that a combination of various tools is more effective than a single intervention. In this way, a more patient-oriented approach is achieved, and patients, physicians and laboratories all benefit.…”