Optimizing Test Utilization
James S. Hernandez, MD, MS, discusses the importance of appropriate laboratory testing.
I’d like to take a few minutes to talk to you about laboratory test utilization.
There are some common misconceptions about this subject. The first is that most doctors are comfortable ordering most tests. Not necessarily true—as the number of tests continually increases, no one can be proficient in all areas. The second is that experienced physicians need less help in ordering and interpreting tests compared to younger colleagues. Also not always true. All physicians have gaps in their knowledge and the gaps are growing because of the number and complexity of available tests. And last is the thought that physicians will get upset if offered help. The opposite is true. If approached as a respected colleague, most physicians welcome your help
In my experience, physicians welcome help from pathologists, laboratory scientists and laboratorians in choosing the best strategy to make a diagnosis or assess therapy using laboratory tests. In addition to suggesting useful tests, the laboratory’s role in creating an environment for this to happen includes eliminating obsolete tests as well as destroying out dated paper requisitions. Also, in primary care settings, consider restricting electronic order access of esoteric tests or eliminating them from requisitions.
Here are some hints on eliminating out-of-date tests:
- Successful lab utilization assumes some degree of integration of the practice.
- Before trying to implement change, get to know your medical staff, especially the informal leaders and recognized experts
- You don’t have to convince every provider, focus on the key users of a particular test, particularly the subject matter experts in that field
- Generate data, be available to answer questions, and continuously give feedback to the medical staff, especially if you see improvements
- Data persuades, emotions motivate—use robust data from your own system; be a true champion.
- Scrutinize your standing orders
- Scrutinize your send-out reference tests for tests that may not add value
- Consider establishing a test utilization review committee at your institution
We recommend literature-supported evidence to guide development of local guidelines, especially cost-effective algorithms, when the differential diagnosis is complex. Mayo Medical Laboratories has developed a set of algorithms for this purpose that may be accessed at www.mayomedicallaboratories.com.
While most test orders are suitable, some are overordered or ordered inappropriately. Through a series of Hot Topics, available at www.mayomedicallaboratories.com, we offer information and data to assist laboratories in their expanding role in appropriate test selection.
Working together with the medical staff, laboratories can help the physician to choose the right test at the right time for the right patient.