Yılmaz Fatma Meriç, Kahveci Rabia, Aksoy Altan, Özer Kucuk Emine, Akın Tezcan, Mathew Joseph Lazar, Meads Catherine, Zengin Nurullah
Yildirim Bayezid University, Department of Biochemistry, Ankara, Turkey.
Ankara Numune Training and Research Hospital, Health Technology Assessment Unit, Ankara, Turkey.
PLoS One. 2016 Apr 14;11(4):e0153693. doi: 10.1371/journal.pone.0153693. eCollection 2016.
Eliminating unnecessary laboratory tests is a good way to reduce costs while maintain patient safety. The aim of this study was to define and process strategies to rationalize laboratory use in Ankara Numune Training and Research Hospital (ANH) and calculate potential savings in costs.
A collaborative plan was defined by hospital managers; joint meetings with ANHTA and laboratory professors were set; the joint committee invited relevant staff for input, and a laboratory efficiency committee was created. Literature was reviewed systematically to identify strategies used to improve laboratory efficiency. Strategies that would be applicable in local settings were identified for implementation, processed, and the impact on clinical use and costs assessed for 12 months.
Laboratory use in ANH differed enormously among clinics. Major use was identified in internal medicine. The mean number of tests per patient was 15.8. Unnecessary testing for chloride, folic acid, free prostate specific antigen, hepatitis and HIV testing were observed. Test panel use was pinpointed as the main cause of overuse of the laboratory and the Hospital Information System test ordering page was reorganized. A significant decrease (between 12.6-85.0%) was observed for the tests that were taken to an alternative page on the computer screen. The one year study saving was equivalent to 371,183 US dollars.
Hospital-based committees including laboratory professionals and clinicians can define hospital based problems and led to a standardized approach to test use that can help clinicians reduce laboratory costs through appropriate use of laboratory tests.
在确保患者安全的同时，减少不必要的实验室检查是降低成本的有效途径。本研究旨在确定并实施相关策略，使安卡拉努穆内培训与研究医院（ANH）的实验室检查更加合理，并计算潜在的成本节约。
医院管理人员制定了一项合作计划；与ANHTA和实验室教授召开了联席会议；联合委员会邀请相关工作人员提供意见，并成立了实验室效率委员会。系统查阅文献，以确定提高实验室效率的策略。确定适用于当地情况的策略并加以实施，在12个月内对其对临床使用和成本的影响进行评估。
ANH各科室的实验室检查使用情况差异极大。内科的使用量最大。每位患者的平均检查次数为15.8次。发现存在对氯、叶酸、游离前列腺特异性抗原、肝炎和艾滋病毒检测进行不必要检查的情况。检验组合的使用被确定为实验室过度使用的主要原因，医院信息系统的检验申请页面进行了重新设计。转移到电脑屏幕上另一个页面的检查项目数量显著减少（减少了12.6%-85.0%）。一年的研究节省金额相当于371,183美元。
由实验室专业人员和临床医生组成的医院委员会能够明确医院存在的问题，并形成标准化的检查使用方法，这有助于临床医生通过合理使用实验室检查来降低成本。
