管理实验室资源的不当使用。

Managing inappropriate utilization of laboratory resources.

作者信息

Cadamuro Janne, Ibarz Mercedes, Cornes Michael, Nybo Mads, Haschke-Becher Elisabeth, von Meyer Alexander, Lippi Giuseppe, Simundic Ana-Maria

机构信息

Department of Laboratory Medicine, Paracelsus Medical University, Müllner Hauptstr. 48, 5020 Salzburg, Austria, Phone: +43-57255-57263, Fax: +43-57255-23199.

Laboratory Medicine Department, University Hospital Arnau de Vilanova, IRBLleida, Lleida, Spain.

出版信息

Diagnosis (Berl). 2019 Mar 26;6(1):5-13. doi: 10.1515/dx-2018-0029.

DOI:10.1515/dx-2018-0029

PMID:30096052

Abstract

Background The inappropriate use of laboratory resources, due to excessive number of tests not really necessary for patient care or by failure to order the appropriate diagnostic test, may lead to wrong, missed or delayed diagnosis, thus potentially jeopardizing patient safety. It is estimated that 5-95% of tests are currently used inappropriately, depending on the appropriateness criteria, thus significantly contributing to the potential of generating medical errors, the third leading cause of death in the US. Content In this review, we discuss the reasons as well as the medical and financial consequences of inappropriate utilization of laboratory tests. We then provide demand management (DM) tools as a means for overcoming this issue and also discuss their benefits, challenges, limitations and requirements for successful implementation. Summary and outlook When based on current evidence, adapted to local conditions and developed in close collaboration with clinicians, DM is a reasonable strategy for progressing toward better management of over- and underuse of laboratory resources.

摘要

背景

实验室资源的不当使用，可能是由于进行了过多对患者护理并非真正必要的检测，或者未开具适当的诊断检测，这可能导致错误、漏诊或诊断延迟，从而有可能危及患者安全。据估计，根据适当性标准，目前有5% - 95%的检测存在不当使用情况，这显著增加了产生医疗差错的可能性，而医疗差错是美国第三大死因。内容：在本综述中，我们讨论了实验室检测不当使用的原因以及医学和财务后果。然后，我们提供需求管理（DM）工具作为解决这一问题的手段，并讨论其益处、挑战、局限性以及成功实施的要求。总结与展望：基于当前证据，因地制宜并与临床医生密切合作制定的需求管理，是朝着更好地管理实验室资源过度使用和使用不足问题迈进的合理策略。