Elnenaei Manal O, Campbell Samuel G, Thoni Andrea J, Lou Amy, Crocker Bryan D, Nassar Bassam A
Department of Pathology and Laboratory Medicine, Novo Scotia Health Authority (NSHA), Halifax, Nova Scotia, Canada Department of Pathology Dalhousie University, Halifax, Nova Scotia, Canada.
Department of Emergency Medicine, Dalhousie University and Queen Elizabeth II Health Science Centre, Halifax, Nova Scotia, Canada.
Clin Biochem. 2016 Feb;49(3):208-12. doi: 10.1016/j.clinbiochem.2015.11.005. Epub 2015 Nov 10.
There is increasing recognition of the importance of appropriate laboratory test utilization. We investigate the effect of a multifaceted educational approach that includes physician feedback on individual test ordering, in conjunction with targeted restriction, on the utilization of selected laboratory tests.
Scientific evidence was compiled on the usefulness and limitations of tests suspected of being over utilized in our laboratories. A variety of approaches were used to deliver education on each of the targeted tests, with greater focus on primary care physicians (PCPs). Feedback on requesting behavior of these tests was also communicated to the latter group which included an educational component. Laboratory based restriction of testing was also exercised, including the unbundling of our electrolyte panel.
PCP requesting patterns for the selected tests were found to be markedly skewed. The interventions implemented over the study period resulted in a substantial 51% reduction in overall ordering of five of the targeted tests equating to an annual marginal cost saving of $60,124. Unbundling of the electrolyte panel resulted in marginal cost savings that equated annually to $42,500 on chloride and $48,000 on total CO2.
A multifaceted educational approach combined with feedback on utilization and laboratory driven gate-keeping significantly reduced the number of laboratory tests suspected of being redundant or unjustifiably requested. Laboratory professionals are well positioned to manage demand on laboratory tests by utilizing evidence base in developing specific test ordering directives and gate-keeping rules.
人们越来越认识到合理利用实验室检查的重要性。我们研究了一种多方面的教育方法的效果，该方法包括针对个体检查医嘱的医生反馈，并结合有针对性的限制措施，对所选实验室检查的利用情况进行研究。
收集了有关我们实验室中疑似过度使用的检查的有用性和局限性的科学证据。采用了多种方法对每项目标检查进行教育，更侧重于初级保健医生（PCP）。还将这些检查的申请行为反馈传达给后一组，其中包括一个教育组成部分。还实施了基于实验室的检查限制，包括拆分我们的电解质检测项目。
发现PCP对所选检查的申请模式明显不均衡。在研究期间实施的干预措施使五项目标检查的总体医嘱大幅减少了51%，相当于每年节省边际成本60,124美元。电解质检测项目的拆分带来了边际成本节省，每年在氯化物方面节省42,500美元，在总二氧化碳方面节省48,000美元。
多方面的教育方法与利用情况反馈以及实验室驱动的把关措施相结合，显著减少了疑似多余或不合理申请的实验室检查数量。实验室专业人员有能力通过利用证据库制定特定的检查医嘱指令和把关规则来管理对实验室检查的需求。
