Research study on the utilisation of laboratory tests

Abstract

Health care spending in the world is widely deemed to be growing at an unsustainable rate, and policy makers increasingly seek ways to slow that growth or reduce spending overall. Studies have shown that, out of the billions of laboratory tests done globally, around 25% are unnecessary or inappropriate, and whatever the context is, these can cause harm and lead to medical errors. Outlining inappropriate testing as one of the main leading sources of waste in the laboratory environment is fundamental in this study. Inappropriate testing can take several forms. Overutilization (over-ordering) refers to tests that are ordered but not indicated and underutilization where tests are indicated but not ordered. In this action research interventional study, the aim is to curb the number of overutilized tests by means of a Minimum Retest Interval (MRI)interventional change to the physician lab test ordering system. Data analysis showcased how 45.3% of the tests have been ordered within the MRI and therefore deemed inappropriate. In par with the literature appraised in this dissertation, this action research has identified a large proportion of the tests ordered has been in violation of the MRI period. This study aimed to bring on a change in the ordering patterns of physician by implementing two types of soft-stops within the clinical ordering system. During these 3 years of tests, exactly 45.3%(n = 118,925) of the laboratory tests were inappropriate repeat tests taken in 19 different locations. Although the difference pre-and post-intervention were not statistically significant, the numbers show it could be, given enough time, as a slight improvement in ordering volumes has been detected. Coupled with a hypothetical saving of around €275,000 per year on tests ordered violating the MRI period, deems this study just the tip of the iceberg in tackling such inappropriateness in the laboratory test ordering system. While the implementation of MRI within the laboratory environment may be deemed the easier option to curb the number of tests, this study shows and recommends stopping inappropriate requests before they reach the laboratory through a scientist-physician educational approach, which has been regarded as the best option in many cited papers.