Chen Michael, Eintracht Shaun, MacNamara Elizabeth
Departments of Diagnostic Medicine, Jewish General Hospital, 3755 Cote Ste Catherine, Montreal H3T 1E2, Canada.
Departments of Diagnostic Medicine, Jewish General Hospital, 3755 Cote Ste Catherine, Montreal H3T 1E2, Canada.
Clin Biochem. 2017 Jan;50(1-2):88-93. doi: 10.1016/j.clinbiochem.2016.06.016. Epub 2016 Nov 9.
Clinical laboratories are under growing pressure to provide faster turn-around-time and maintain high quality while decreasing costs. In a setting of rising test volumes, implementation of evidence-based protocols with physician cooperation and feedback may provide frameworks and support for laboratory utilization optimization. The purpose of this study was to eliminate wasteful urine microscopy by targeting physician ordering behavior, and to ensure quality of care with physician satisfaction surveys.
We evaluated how physicians use the laboratory for routine urine testing. Urinalysis requisition was redesigned with emphasis on clinical indications for testing. In collaboration with requesting physicians, restriction in reflex microscopy testing was applied with exceptions. Cost saving analysis was conducted based on test volume. After policy change, 2 physician satisfaction surveys were conducted 5year apart to address potential complaints.
Over 47,000 urine microscopies have been eliminated annually, while the number of urine dipsticks and cultures remained stable. This translated into a 95% reduction in manual microscopy performed, and an estimated annual saving of $200,000. In both satisfaction surveys, 9 out of 10 physicians considered the change to have "no" or "a beneficial effect" on their clinical practice. Our laboratory did not receive any formal complaints in regards to the protocol change.
By implementing changes to the way physicians order urinalysis, the number of tests can be substantially reduced. Satisfaction survey proved to be an effective tool for obtaining physician feedback, and support. The results of surveys indicated that new policy achieved significant savings without compromising on patient care. This experience has provided us with strategies on taking initiatives to further optimize utilization of laboratory tests.
临床实验室在加快周转时间、保持高质量并降低成本方面面临着越来越大的压力。在检测量不断增加的情况下，实施基于证据的方案并获得医生的合作与反馈，可为实验室利用优化提供框架和支持。本研究的目的是通过针对医生的开单行为消除不必要的尿液显微镜检查，并通过医生满意度调查确保医疗质量。
我们评估了医生如何使用实验室进行常规尿液检测。重新设计了尿液分析申请单，重点关注检测的临床指征。与申请医生合作，对反射显微镜检查进行了限制，但有例外情况。根据检测量进行了成本节约分析。政策改变后，相隔5年进行了两次医生满意度调查，以解决潜在投诉。
每年已消除超过47000次尿液显微镜检查，而尿试纸和培养的数量保持稳定。这使得手工显微镜检查减少了95%，估计每年节省20万美元。在两次满意度调查中，十分之九的医生认为这一改变对他们的临床实践“没有”或“有有益影响”。我们的实验室没有收到任何关于方案改变的正式投诉。
通过对医生开单进行尿液分析的方式进行改变，可以大幅减少检测数量。满意度调查被证明是获得医生反馈和支持的有效工具。调查结果表明，新政策在不影响患者护理的情况下实现了显著的节约。这一经验为我们提供了主动采取措施进一步优化实验室检测利用的策略。
