Providing clinicians with information on laboratory test costs leads to reduction in hospital expenditure (original) (raw)
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Background: Overutilization of investigations, leads not only to excessive burden on the laboratory but also gives rise to a multitude of problems in patient management. Practice of evidence based laboratory medicine and awareness of cost effectiveness of tests amongst prescribing clinicians is hence of paramount importance to address this problem. Aim: The aim of this study is to analyse the prescribed requisitions for common hematological and biochemical tests and determine the prevalence of the “inappropriate” and “avoidable” tests. Materials and Methods: We conducted a retrospective cross- sectional study on hospital records of 150 male patients admitted to acute medical and surgical wards from 01 Dec 2015 to 29 Feb 2016 at a tertiary care teaching hospital located in North India. The tests requisitions for routine biochemical and hematological investigations during period of admission were analysed and categorized into three categories by a panel of three doctors: appropriate, inappropriate and avoidable. Results: In our study we analysed 10236 requisitions of common biochemical and hematological tests ordered for 150 admitted male patients and found that only 50.4% tests were clinically “appropriate”. 22.4% of the total tests performed were “inappropriate” and hence were wasteful. 27.2% of tests were categorized as “avoidable”. Conclusion: This study provides a detailed insight into the investigation requisition pattern for most common hematological and biochemical investigations which form a major part of workload in a clinical laboratory. The study shows that a considerable number of investigations are inappropriate and do not contribute to patient management in any manner. These tests are a drain on the resources and hence must be eliminated by formulation of strict guidelines and protocols. On the other hands there are some avoidable test orders which arise from inability of the clinicians to prescribe tests in accordance to pretest probabilities and evidence based practice. These avoidable tests can be reduced by interactive education of the clinicians.
COST EFFECTIVE UTILISATION OF DIAGNOSTIC TESTS: HOW GOOD ARE WE AS DOCTORS
Keywords: '', 'medical leadership'. The NHS Leadership framework requires every doctor to be involved in the effective running of the unit they work in. This requires doctors to effectively use the resources available in order to provide high quality patient care. However, for effective use of resources, doctors need to understand the cost of the investigations they are requesting. This will reduce the number of unnecessary and duplicate investigations and ensure that sound medical rationale has been applied before requesting investigations.
Journal of Multidisciplinary Healthcare
Background: The use of diagnostic laboratory tests is increasing worldwide. Improper test utilization (ITU) is a common problem for all healthcare systems as it costs substantial expenses for the health systems and impacts optimal patient care. Purpose: The present small-scale survey aims to highlight the current practice of ITU among the labs and physicians, and investigate the actions of diagnostic laboratories towards ITU, and identify the reasons affecting test ordering decisions among physicians. Methods: A cross sectional study based on two different surveys was developed and distributed from March 2017 to April 2017 to laboratory supervisors and physicians (clinicians) at Hamad Medical Corporation (HMC), Qatar. Fourteen laboratory supervisors and eighty-nine physicians were surveyed about improper test utilization practices. The overall results are descriptive data. Results: The overall proportion of improperly utilized tests detected by the laboratory supervisors were 50.0%, 35.7%, and 14.3% for overused, misused, and underused lab tests, respectively. Among the physicians, 91% used the electronic ordering template to select the appropriate tests. Moreover, 78.7% of the physicians used the clinical guidelines, while 73% were not employing the laboratory handbook. Furthermore, 95.5%% of the physicians preferred to get feedback about inappropriate tests, while 51.1% were not receiving any, and 40.9% were rarely receiving. Finally, 67.4% were unaware of the tests' costs among surveyed physicians, and 63.6% showed a willingness to reduce their orders if the cost was high and unnecessary. Conclusion: The physician's and the laboratories' communication were inadequate and not systematized, causing ITU practices. The improvement strategy should focus on the communication between clinical labs and physicians and enhance physician implementation to order appropriate lab tests. This could be achieved by conducting legitimate educational methodologies, continuous feedback reviews, ongoing audits, executing health information technology instruments, engaging laboratory practice guidelines, and applying demand management and testing algorithms.
BMC Health Services Research, 2013
Background: In recent years inappropriate and excessive use of clinical laboratory facilities has become a cause of concern and has led to concurrent rise in the laboratory errors and the health care costs. The aim of the study was to find out the frequency of incomplete laboratory request forms, inappropriate test requests at various professional levels and the financial impact of uncollected reports at Armed Forces Institute of Pathology (AFIP) and Combined Military Hospital (CMH) Laboratory Rawalpindi. Methods: The cross-sectional descriptive study was conducted during a three month period from April to June 2012 at AFIP and CMH Laboratory Rawalpindi. A total of 1000 laboratory request forms were collected and scrutinized for completion from AFIP (n=500) and CMH Rawalpindi laboratory (n=500). 536 request forms of costly/specialized tests from different departments of AFIP were studied to find out the professional level of test request. The total number of tests performed at AFIP during the study period and number of uncollected reports were noted. The financial impact of these uncollected reports was also calculated. Collection of data and sorting were done manually. Patient confidentiality was maintained. Microsoft excel software and SPSS-17 were used for analysis. The study was approved by the Institutional Ethical Review Committee. Results: Out of a total of 1000 forms studied none was completely filled with clinical notes being present in only 2.4% and 13% of forms sent to CMH and AFIP respectively. 62% of the expensive investigations were requested by specialists while 38% were ordered by residents and general practitioners but the percentage of avoidable expensive tests ordered by the general practitioners and residents was significantly higher than the specialists (p<0.001). A total of 9026 (40%) and 5046 (22%) diagnostic test reports were not collected from the Chemical pathology and Hematology departments respectively. Financial impact of uncollected reports from all the departments at AFIP collectively amounted to Pakistani Rupees (PKR) 3338201. Conclusion: Processing incomplete laboratory request forms and injudicious use of laboratory facilities leads to incorrect interpretation of laboratory test results affecting outcome of the overall treatment.
The add value of laboratory diagnostics: the many reasons why decision-makers should actually care
Journal of Laboratory and Precision Medicine, 2017
The role and responsibilities of laboratory professionals are impressively changing. Clinical and technical background is no longer sufficient, since laboratory activity is now increasingly committed to manage organizational, administrative and economic concerns. Although the relationship between costs, revenues and profits is indeed straightforward for public laboratories, with much larger profitability than many other industries, laboratory professionals are still struggling to survive. While most public hospitals are besieged to reach the break-even and stay afloat, public laboratories only receive a fraction of what they bill, but are largely contributing to generate economic revenues that will ultimately contribute to offset the hospital losses. Whatever profitability analyst would hence see as quite masochistic to kill the golden goose. In this dissertation, we are hence aiming to provide some useful elements to convince decision-makers that laboratory medicine is not a deadwood, but is probably the key for a patient-centered and sustainable future of health care.
International Journal for Quality in Health Care, 2005
Background. Improving the appropriateness of testing behavior and reducing the number of laboratory tests have been recognized as essential parts of quality improvement. Objective. To assess the effectiveness of an administrative and a short-term educational intervention aimed at reducing clinical biochemistry laboratory utilization. Design. An analysis comparing utilization of laboratory tests performed on in-patients before and after the intervention.
Background: Diagnostic health laboratory services are regarded as an integral part of the national health infrastructure across all countries. Clinical laboratory tests contribute substantially to health system goals of increasing quality of care and improving patient outcomes. Objectives: This study aimed to analyse current laboratory expenditures at the primary healthcare (PHC) level in South Africa as processed by the National Health Laboratory Service and to determine the potential cost savings of introducing laboratory demand management. Methods: A retrospective cross-sectional analysis of laboratory expenditures for the 2013/2014 financial year across 11 pilot National Health Insurance health districts was conducted. Laboratory expenditure tariff codes were cross-tabulated to the PHC essential laboratory tests list (ELL) to determine inappropriate testing. Data were analysed using a Microsoft Access database and Excel software. Results: Approximately R35 million South African Rand (10%) of the estimated R339 million in expenditures was for tests that were not listed within the ELL. Approximately 47% of expenditure was for laboratory tests that were indicated in the algorithmic management of patients on antiretroviral treatment. The other main cost drivers for non-ELL testing included full blood count and urea, as well as electrolyte profiles usually requested to support management of patients on antiretroviral treatment. Conclusions: Considerable annual savings of up to 10% in laboratory expenditure are possible at the PHC level by implementing laboratory demand management. In addition, to achieve these savings, a standardised PHC laboratory request form and some form of electronic gatekeeping system that must be supported by an educational component should be implemented
Managing the demand for laboratory testing: Options and opportunities
The possibilities for ordering laboratory testing in hospitals inevitably need to be managed, given physicians' knowledge on the use of laboratory testing, their attitudes towards test ordering, the constant increase in testing and the limited resources available. On the assumption that some tests may not be strictly necessary or are even redundant, this paper reviews various methods to manage the demand for laboratory tests, evaluating the extent to which these methods are applicable and effective in daily practice. The most promising new management tools seem to be computerised laboratory management systems (CDSS), a reimbursement system based on the diagnosis–treatment combination (as in The Netherlands), and the allocation of laboratory budget to those requesting laboratory services.