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Optimal Utilization of Laboratory Testing



Interventions to Improve Lab Utilization7

Slide 24

November 2011

And here's some interventions to improve lab utilization. This is based on the work of Dr. Michael Astion in Seattle. He and I have worked together on trying to improve test utilization. Posting guidelines on test requisitions and computerized reminders regarding timelines, they make us feel pretty good but that's pretty gentle guidance. It doesn't always help to change the practice patterns. Next, are utilization report cards similar to what we’ve done in transfusion medicine and changes to the manual requisition or CPOE–physician order entry. And if we make those changes so we make it possible so that we can guide toward algorithms or toward judicious use of tests, that can be quite helpful. Finally, if we can do as we've done in Transfusion Medicine, have utilization report cards with peer review. This is based on data mining in your own system and any clinicians as well as pathologists and scientists in the same room to do some peer review. Higher level approval or consultation may be required for some of these more esoteric tests. And finally, the strictest guide is utilization report cards with leadership review and incentives or penalties to encourage that behavior. Some academic centers have actually gone as far as forbidding some tests. Having a green, yellow, and red pattern so that everyone can order green tests, only a few can order yellow, and red are completely forbidden unless there is explicit permission to order those tests.

Interventions to Improve Lab Utilization7
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