| The Importance of Laboratory Test Utilization Management |
| Kristen Croom, MLS(ASCP), MB(ASCP) |
Some research has shown that approximately 70% of medical decisions are based on laboratory tests. Most clinicians and healthcare workers realize the importance of the laboratory and acknowledge the vital role that laboratory medicine plays in the care of our patients. The push by the government to base reimbursement on quality measures has put a spotlight on the laboratory to ensure that testing is appropriate for the patient.
Along with ensuring quality patient care the healthcare institutions are expected to operate within tighter margins due to reduction of reimbursements from payer across the board. One method to ensure quality patient care and reducing overall healthcare resource utilization is to evaluate laboratory test utilization within an inpatient and outpatient setting. An inappropriate test can fall into one of three categories: tests are ordered but are not directly indicated, initial testing is inappropriate based on patient evaluation, or repeated “routine” testing is not a necessity (Mora et al., 2017). One study stated that the ordering of a complete blood count (CBC) was the most common routine test ordered and accounted for $32.7 million in 2009 (Rao, 2014). In addition to a waste of money inappropriate lab orders can result in unnecessary blood draws that could result in patient harm and increase false-positive results (Mora et al.)
There are a multitude of scientific articles that have researched the advantages to creating a laboratory utilization program in each healthcare organization. Mora et al. provided the ten most frequent processes used to optimize lab test utilization:
1. Determine the clinical reasoning behind the most frequently ordered lab tests;
2. Present comprehensive aggregate data to physicians: case mix index, lab tests costs, budgeted goals, outcomes, quality metrics, trends, and individual physician ordering practices;
3. Provide information from peer-reviewed publications that include evidence-based lab utilization practices for the patient populations being treated;
4. Provide information on the potential clinical implications of lab ordering patterns;
5. Provide comparative data from other units or hospitals that have different patterns of lab utilization but have similar types of patients or similar case mix index values;
6. Select a physician champion who will organize educational sessions and provide the information required for improving lab test utilization;
7. Develop goals and a method for measuring and communication successful lab test utilization management through frequent meetings that will sustain practice changes;
8. Reduce or eliminate standing orders for lab tests;
9. Determine whether specific directives are necessary, e.g. having blood drawn on specific days unless there is a specific medical necessity;
10. Engage all executive administrative staff and provide effective and non-judgmental communications to all physicians involved in patient care.
The bottom line is that a lab utilization program can save patients’ lives and save the healthcare institution money. While the structure of the programs may vary from institutions to institution, the key factors are open, honest communication using evidence-based practice in a non-judgmental environment.
References
1. Mora, MD, A., Krug, MHA, B. S., Grigonis, PhD,, A. M., Dawson, PhD., A., Jing, MS, Y., & Hammerman, MD, S. I. (2017). Optimizing laboratory test utilization in long-term acute care hospitals. Baylor University Medical Center Proceedings, 26-29.
2. Rao, S. K. (2014). Utilization management in the changing health-care environment. Clinical Chimica Acta, 109-110.
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