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Laboratory Test Utilization Strategies

Use of Educational Efforts and the Test Ordering System

Published: March 2013

Hot Topic Q&A is an opportunity for viewers to submit questions to the Hot Topic presenter. The opportunity to submit questions for this topic is now closed.

The following questions were submitted by viewers and answered by the presenter, Bobbi S. Pritt, MD, Associate Professor of Laboratory Medicine and Pathology, College of Medicine, Director of the Initial Processing and Media Laboratory and the Parasitology Laboratory, and Consultant in the Division of Clinical Microbiology, all at Mayo Clinic in Rochester, Minnesota.

Questions are presented as submitted (unedited).

  1. Many Labs are deficient in IT resources, so this needs to become a top-down initiative.

    We agree that IT resources are often a limiting aspect of test utilization (TU) efforts, and that having leadership support can help prioritize TU IT requests more highly. We were able to get leadership support by gathering data on project money SAVED by the lab if we were to implement some simple IT changes. We found that seeing real dollar amounts attached to utilization efforts got the attention of our leadership and immediately garnered their support.

    If you still aren’t able to get IT support for some of the more complex types of changes (eg, monitoring of orders by physician and practice, having your IT system recognize duplicate orders or set limits on ordering), then I would recommend starting with simple changes first.

    For example, changing the name of a test that is commonly misordered is a relatively easy, yet surprisingly effective, method for optimizing TU. I’ll use our beta-HCG test as an example; clarifying which version of the test was for cancer monitoring and which was for pregnancy testing by renaming the tests was something that we could easily do. For labs that are using paper requisition forms, it is just a matter of updating those forms (still involving a fair amount of work, but not requiring IT expertise).

    So in summary, I would recommend trying to gather real cost savings data to help get leadership support, but also look for ways that you can use your existing resources to make small changes. I would also recommend getting out and talking to your clinical colleagues to get their support. Test utilization and cost savings are on everyone’s mind these days and it is likely that they are already thinking of ways to curb unnecessary testing. If you have a large department (eg, Internal medicine) on your side, then you have more leverage with leadership.

  2. How can we use Mayo algorithms in our lab?

    There are a couple of ways that you can use the Mayo algorithms.

    The first is to use them as part of an educational packet when meeting with your clinical colleagues to discuss laboratory test utilization. As I mentioned above, many clinicians are already looking for ways to curb unnecessary testing and may welcome your assistance. The Mayo algorithms are based on national guidelines and can therefore be part of your packet of information to help guide them with test ordering. We find that many physicians find these algorithms useful; some even laminate the printed versions and hang them next to their computer for easy reference. Algorithms can also be downloaded to iPads and other electronic devices.

    The second method is to use the Mayo algorithms that are already embedded into the order process. For example, the Celiac Cascade, contains multiple test that are embedded in an algorithm that is controlled by the lab (CDCOM Celiac Disease Comprehensive Cascade).

    Based on initial testing results, additional tests will be performed by the laboratory on the specimen that was submitted. Although the cascade includes multiple different tests, only 2 tests are performed in most situations. Therefore, the final cost of the cascade is considerably lower than if all possible celiac tests had been ordered upfront.

    Another example is the Lupus Anticoagulant Profile.

    Once again, only the tests that are appropriate are performed. Most require no more than initial screening. However, if further action is required for interpretation, additional tests will be performed on that same specimen, allowing for rapid turnaround time for the clinician and convenience for the patient.

    There are several more examples of these algorithms on the Mayo Medical Laboratories website.

    Best wishes with your utilization efforts!
    Bobbi Pritt, MD